TX HHS Form H3038-P. CHIP Perinatal - Emergency Medical Services Certification
Form H3038-P is used in Texas to document that a non-citizen patient received treatment for a true medical emergency.
TX HHS Form H1053-IME. Provider Notice of Incurred Medical Expense Decision
The Provider Notice of Incurred Medical Expense Decision (Form H1053-IME) is a communication tool used by the Texas Health and Human Services Commission (HHSC). It informs long-term care providers about HHSC’s decision to approve or deny an individual's Incurred Medical Expense (IME).
TX HHS Form H1073. Personal Responsibility Agreement
The Personal Responsibility Agreement (PRA), documented through Form H1073, is a core requirement for Texans applying for or receiving Temporary Assistance for Needy Families (TANF).
TX HHS Form H0059. Notification of Annuity Remainder Beneficiary
This document is used by Texas Health and Human Services (HHS) to formally notify an insurance company that the State of Texas must be listed as the preferred remainder beneficiary on an annuity owned by a Medicaid applicant.
TX HHS Form 8509. Unlicensed Personnel Tracking of Delegated Tasks
Form 8509 is used in healthcare settings to document tasks that a Registered Nurse (RN) delegates to unlicensed personnel.
TX HHS Form 4004. Residential Child Care Licensing Environment Health Checklist
The Residential Child Care Licensing Environmental Health Checklist for Foster Homes (Form 4004) is designed to ensure that foster family homes in Texas meet the environmental health and safety standards set by the Texas Health and Human Services Commission (HHSC).
TX HHS Form 5503-MA. Verification of Curriculum by an Accredited School of Nursing
The Form 5503-MA, Medication Aide Program Verification of Curriculum, is used by the Texas Health and Human Services Commission (HHSC) to verify that the courses completed by a medication aide applicant meet the curriculum requirements specified in TAC 557.107(c)(2).
TX HHS Form 2960 Attachment C. CCR Application for a License to Operate a Residential Child Care Facility
Form 2960 Attachment C is a required supplement to the application for operating a general residential operation (GRO) in Texas that provides treatment services to children with emotional disorders.
TX HHS Form 2960 Attachment B. CCR Application for a License to Operate a Residential Child Care Facility
Form 2960 Attachment B is an essential guide for applicants seeking a license to operate a Residential Child Care Facility (RCCF) in Texas.
TX HHS Form 2960 Attachment A. CCR Application for a License to Operate a Residential Child Care Facility
Form 2960 Attachment A is a detailed checklist used in Texas when applying for a license to operate a General Residential Operation (GRO).