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

161 - 180 of 366 forms

Form Title	Topics
Form 3249, Hospital Waiver Request
Form 3250, Hospital Statute and Rule Waiver Request Application for Facility Physical Plant and Construction Requirements
Form 3255, Fire Safety Survey Report for Hospitals and Crisis Stabilization Units
Form 3256, Chemical Dependency Treatment Facility Variance Request Application
Form 3257, Licensed Chemical Dependency Counselor Peer Assistance Program Application
Form 3258, Licensed Chemical Dependency Counselor Program Peer Assistance Program Access Attestation
Form 3259, Chemical Dependency Treatment Facility Court Commitment or Emergency Detention Acceptance Application
Form 3596, PAS/Habilitation Plan – CLASS/DBMD/CFC
Form 3608, Individual Plan of Care (IPC) – HCS/CFC
Form 3611, Involuntary Termination of Consumer Directed Services IPC Cover Sheet
Form 3612, Transfer Process Checklist
Form 3613-A, SNF, NF, ICF/IID, ALF, DAHS and PPECC Provider Investigation Report with Cover Sheet
Form 3613, Provider Investigation Report with Fax Cover Sheet (Home Health, Hospice and Personal Assistance Services Provider Use Only)
Form 3615, Request to Continue Suspension of Waiver Program Services
Form 3617, Request for Transfer of Waiver Program Services
Form 3618, Resident Transaction Notice
Form 3619, Medicare/Skilled Nursing Facility Patient Transaction Notice
Form 3621, CLASS/CFC — Individual Plan of Care
Form 3621-T, CLASS/CFC – IPC Service Delivery Transfer Worksheet
Form 3624, Termination, Reduction or Denial of CLASS

Texas Health and Human Services