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HHS forms are used every day to perform tasks such as applying for benefits, contracting to provide goods or services, reporting incidents, declaring end of life wishes, and conducting other business.

ES = Spanish version available.

Title
Form 8584, Nursing Comprehensive Assessment ES
Form 8583, HCS and TxHmL Program Contact Information ES
Form 8582, TxHmL-CFC Individual Plan of Care
Form 8580, Request for Variance of Supported Employment – Employer Requirements
Form 8575, Notification of Local Authority (LA) Reassignment
Form 8574, Administration of Medications by Unlicensed Personnel
Form 8572, TxHmL Individual Profile Information
Form 8509, Unlicensed Personnel Tracking of Delegated Tasks
Form 8494, Notification Regarding an Investigation of Abuse, Neglect or Exploitation
Form 8493, Notification Regarding a Death in HCS, TxHmL and DBMD Programs
Form 8492, Random Sample Review of Nursing On-Call Required Submission of Documentation
Form 5842, TxHmL Financial Eligibility Information
Form 4118, Respite Service Delivery Log
Form 4117, Supported Employment/Employment Assistance Service Delivery Log
Form 4116-Dental, Dental Summary Sheet
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