Texas Health and Human Services Forms and Office Locations – Government Agency in Texas

1 - 20 of 366 forms

Form Title	Topics
Declaration for Mental Health Treatment
Directive to Physicians and Family or Surrogates
Form 0003, Authorization to Furnish Information
Form 0006, Service Provider Printed Forms Order
Form 1014, Pre-Admission Screening and Resident Review (PASRR) Evaluation Summary Report
Form 1019, Opportunity to Register to Vote/Declination
Form 1022, Authorization to Disclose Information Including Protected Health Information for Referral to Another Agency/Organization
Form 1024, Individual Status Summary
Form 1026-TSI, Verification of Railroad Retirement Benefits - TSI
Form 1027, Caregiver Status Questionnaire
Form 1041, Refusal of PASRR Mental Illness Specialized Services
Form 1045, Request for Extension of Enrollment Offer Due Date
Form 1048, Summary Sheet for Services to Individuals with IDD in a Nursing Facility
Form 1051, Request for Determination of Intellectual Disability (DID)
Form 1052, Public Provider Choice Request
Form 1058, Request for Home and Community-based Services Crisis Diversion Slot
Form 1060, Health and Developmental Services (HDS) Promotion and Outreach Quarterly Report Promotion and Outreach Quarterly Report
Form 1067, Offer of Home and Community-based Services (HCS) Program
Form 1069, Withdrawal of Offer of Texas Home Living Program
Form 1090, Oral Evaluation and Fluoride Varnish Certification Application

Texas Health and Human Services