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 3698, Resident Fund Surety Bond
Form 8625-D, Designation of a Long-Term Care Ombudsman as Representative and Request to Appeal a Nursing Facility Discharge
Form 5830, Community-based Programs – Community Care Services Contracts (CCSC) - Contract Application Packet Checklist, State Office Enrolled
Form 6103, End Stage Renal Disease Facility Incident Report
Form H3038, Emergency Medical Services Certification ES
Form 1680, Texas Money Follows the Person Demonstration Grant Expenditure Report
Form H3038-P, CHIP Perinatal - Emergency Medical Services Certification ES
Medical Power of Attorney Designation of Health Care Agent (MPOA) ES
Declaration for Mental Health Treatment (DMHT) ES
Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) Order ES
Form 1736, Documentation of Employer Orientation by Financial Management Services Agency
Form 1034, PASRR Service Delivery Log
Form 1030, PASRR Implementation Plan
Form 8799, PASRR Assessments for IDD Habilitative Specialized Services
Form H1700-1, STAR PLUS HCBS Program Individual Service Plan ES