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 6111, Limited Services Rural Hospitals Incident Report
Form 3035, Kidney Health Care Program Application ES
Form 7484, Hospital Report for Newborn Child or Children
Form 3713, Nursing Facility Consent for Antipsychotic or Neuroleptic Medication Treatment
Form 3242, Military Member, Military Spouse and Military Veteran Supplemental
Form 1348, Texas Medicaid Phosphate Binders Prior Authorization Request
Form 5989, Contract Monitoring Entrance Conference
Form 6001, Children's Autism Program Key Personnel Change Request
Form 4214, Request for Non-Emergency Medical Transportation (NEMT) Services
Form 1356, Texas Medicaid Xyrem Prior Authorization Request
Form 8618, State Long-Term Care Ombudsman Program Initial Certification Training Log
Form 5879, Relocation Services Contract (Provider Agreement)
Form 1353, Texas Medicaid OxyContin Prior Authorization Request
Form 5541, Corrections Medication Aide Program General Statement Enrollment
Form 3854-A, Emergency Response Services Procedures