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 2823, Local Mental and Behavioral Health Authority Referral
Form 1598-ICF-NP, Bed Hold Payment Attestation
Form 3712, Temporary Medicaid Spend-Down Bed Request
Form 2822, Notification of Change in RTC Project Case Status ES
Form 3711, Request for Bed Changes and Bed Relocations
Form 8516, Electronic Visit Verification Responsibilities and Additional Information
Form 8626, Media Release – Authorization to Photograph or Record a Resident of a Nursing or Assisted Living Facility ES
Form 1204, Government Performance and Results Act (GPRA) Assessment Participant Information Sheet ES
Form 1598, Retainer Payment Attestation
Form 0012, Request for Interstate Transfer
Form 8636, Volunteer/Intern Assignment Description
Form 0011, Consent to Transfer to a Texas State Operated Facility
Form 3092, Medication Administration Record
Form 6004, Texas Provider Marketing
Form 3091, HCBS-AMH Comprehensive Nursing Assessment