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Forms

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 2277, Client Information Release ES
Form 2275, Client Rights and Responsibilities ES
Form 8627, Request for Review of Individual Plan of Care (IPC) Cost Over Maximum Cost Ceiling Cover Sheet
Form 8608, Sample Appeal Letter
Form 8601, Verification of Freedom of Choice
Form 8599, Individual Plan of Care (IPC) Cover Sheet
Form 8586, TxHmL Service Coordination Notification
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
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