TX HHS Form H1239. Request for Verification of Bank Accounts
Form H1239, titled “Request for Verification of Bank Accounts”, is an official document used by the Texas Health and Human Services Commission (HHSC) to verify financial information for individuals being evaluated for medical assistance programs.
TX HHS Form 5401. Media Release Authorization to Photograph or Record a Resident of a State Supported Living Center (SSLC) or Patient of a State Hospital (SH)
Form 5401 is an official authorization used by Texas Health and Human Services (HHS) to obtain consent for photographing, audio recording, or video recording a resident of a State Supported Living Center (SSLC) or a patient of a State Hospital (SH).
TX HHS Form 8605. Documentation of Completion of Purchase
Form 8605 is an official Texas Health and Human Services document used to confirm that a purchase or modification funded through certain Medicaid waiver programs has been completed and reviewed.
Form MC-025. Attachment to Judicial Council
Form MC-025 is a standardized attachment form approved by the Judicial Council of California. It is used to add extra pages or detailed explanations to many different California court forms when the original form does not provide enough space.
TX HHS Form 3713. Nursing Facility Consent for Antipsychotic or Neuroleptic Medication Treatment
Form 3713, titled “Nursing Facility Consent for Antipsychotic or Neuroleptic Medication Treatment”, is an official Texas Health and Human Services form used in nursing facilities when antipsychotic or neuroleptic medications are prescribed to a resident.
TX HHS Form 3225. Application for Certification Supplement to CMS 116
Form 3225 is an official supplemental document used as part of the Clinical Laboratory Improvement Amendments (CLIA) certification process in the United States.
TX HHS Form 2982. Personal History Statement
Form 2982, titled Personal History Statement, is a required document used by Texas Child Care Regulation (CCR) as part of the licensing process for child care and certain residential care operations.
TX HHS Form 3248. Chemical Dependency Counselor Intern Registration Application
Form 3248 is the official application used in Texas to register as a Chemical Dependency Counselor Intern (CI).
TX HHS Form 2838. Miscellaneous Program Request for Exemption from Child Care Regulation
Form 2838 is an official Texas Health and Human Services Commission (HHSC) document used by certain programs to request an exemption from Child Care Regulation (CCR).
TX HHS Form H1801. SNAP Worksheet
Form H1801, known as the SNAP Worksheet, is an internal eligibility and calculation document used in the administration of the Supplemental Nutrition Assistance Program (SNAP).