Form 3043 is the Texas-adopted version of the Child and Adolescent Needs and Strengths (CANS) assessment for youth ages 6 to 17. It is used by mental health professionals to systematically evaluate a child’s risks, behavioral and emotional needs, life functioning, strengths, caregiver capacity, and cultural factors in order to support clinical decision-making, service planning, and program eligibility.
The TX HHS Form 3044, Home and Community Based Services Adult Mental Health (HCBS-AMH) Settings Checklist, is a practical tool used to ensure compliance with adult mental health settings in Texas. This biennial report helps identify potential concerns or heightened scrutiny situations that may require follow-up actions.
The TX HHS Form 3045, Presumptive Eligibility Notice, is a crucial document that helps address immediate medical or dental needs of clients who are unable to complete the eligibility determination process at the time of application. This form is typically used in situations where clients require temporary eligibility for primary health care services or Title V Maternal and Child Health Fee-for-Service programs.
The TX HHS Form 3047, Notice of Ineligibility, is a crucial document for individuals who have applied for various health programs in Texas. This form serves as a notification to applicants that their application has been denied due to not meeting the program eligibility requirements.
The TX HHS Form 3048, Notice of Eligibility, is a crucial document that helps individuals or households receive approved services for the Epilepsy program. This form is typically used in situations where an application has been approved, and the recipient needs to be notified of the services provided and their responsibilities.
The TX HHS Form 3049, Employment Verification, helps determine the eligibility of a household applying for health care assistance from various programs. This form is typically completed by an employer to verify the employment status of an individual who is receiving or has received benefits.
The TX HHS Form 3053, Notification of Rights and Responsibilities, Complaint Procedures, and Allegations of Abuse, Neglect or Exploitation, is a crucial document that helps individuals receiving Home Delivered Meals (HDM) understand their rights and responsibilities. This form is typically used in situations where an individual requires assistance with meal delivery due to age, disability, or other circumstances.
The TX HHS Form 3054, Primary Home Care Service Delivery Record, is a crucial document that helps track the delivery of primary home care services to individuals. This form is typically used in situations where multiple caregivers are involved in providing care to an individual, ensuring that all tasks and responsibilities are accurately recorded and accounted for.
The TX HHS Form 3055, Physician's Orders for Day Activity and Health Services (DAHS), is a crucial document that helps healthcare professionals provide essential care to adults with chronic medical conditions. This form is used in situations where individuals require ongoing support and services to manage their health needs. Typically, physicians or other authorized healthcare providers fill out this form to outline the necessary orders for DAHS program providers.
The TX HHS Form 3057, Kidney Health Care Program Physician Assessment, is a crucial document that helps solve the problem of verifying an applicant's medical information for the Kidney Health Care Program. This form is used in situations where a signed and dated copy of the CMS 2728 form is not available.
