Home and Community-based Services Handbook
Forms Table of Contents
For information about forms accessibility, contact DADS at handbookfeedback@dads.state.tx.us
| 0702 | Fax Cover Sheet for TxHmL and HCS | ||
| 1573 | Residential Review Evidence of Correction for Results Less Than 90% | ||
| 1577 | Personal Care Services Selection | ||
| 1581 | Consumer Directed Services Option Overview | ||
| 1581-S | Consumer Directed Services Option Overview (Spanish) | ||
| 1582 | Consumer Directed Services Responsibilities | ||
| 1582-S | Consumer Directed Services Responsibilities (Spanish) | ||
| 1583 | Employee Qualification Requirements | ||
| 1583-S | Employee Qualification Requirements (Spanish) | ||
| 1584 | Consumer Participation Choice | ||
| 1584-S | Consumer Participation Choice (Spanish) | ||
| 1586 | Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option | ||
| 1586-S | Acknowledgment of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option (Spanish) | ||
| 1588 | HCS Review Report | ||
| 1592 | RN Delegation Checklist | ||
| 1740 | Service Backup Plan | ||
| 1741 | Corrective Action Plan | ||
| 1741-S | Corrective Action Plan (Spanish) | ||
| 2067 | Case Information | ||
| 2125 | Home and Community-based Services Implementation Plan | ||
| 3605 | HCS Parent or Legally Authorized Representative (LAR) Contact Information for Individuals Under 22 Years of Age | ||
| 3605-S | HCS Parent or Legally Authorized Representative (LAR) Contact Information for Individuals Under 22 Years of Age (Spanish) | ||
| 3608 | Individual Plan of Care (IPC) - Home and Community-based Services | ||
| 3609 | Waiver Survey and Certification Residential Checklist | ||
| 3610 | Non-Compliance Determintation Informal Review Request | ||
| 3611 | Involuntary Termination of Consumer Directed Services (CDS) Individual Plan of Care (IPC) Cover Sheet (HCS and TxHmL) | ||
| 3612 | Transfer Process Checklist | ||
| 3615 | Request to Continue Suspension of Waiver Program Services | ||
| 3616 | Request for Termination of Waiver Program Services | ||
| 3617 | Request for Transfer of Waiver Program Services | ||
| 4116-Dental | Dental Summary Sheet | ||
| 4116-MHM-AA | Minor Home Modification/Adaptive Aids Summary Sheet | ||
| 4122 | Foster/Companion Service Delivery Log | ||
| 4122-S | Foster/Companion Service Delivery Log (Spanish) | ||
| 5035 | Request for Exception to Service Limit | ||
| 5606 | Life Safety Code Certification | ||
| 5607 | Waiver Survey and Certification DFPS Checklist | ||
| 5610 | HCS Fire Drills, Four-Person Home Inspections and Approvals | ||
| 5611 | HCS Personnel Checklist | ||
| 8493 | Notification to DADS Regarding a Death in HCS, TxHmL and DBMD Programs | ||
| 8494 | Notification to DADS Regarding DFPS Investigation | ||
| 8575 | Notification of Local Authority (LA) Reassignment | ||
| 8576 | Individual Profile Information | ||
| 8578 | Intellectual Disability/Related Condition Assessment | ||
| 8579 | Notification of Service Coordinator (SC) Disagreement | ||
| 8580 | Request for Variance of Supported Employment - Employer Requirements | ||
| 8581 | Corrective Action Plan Form | ||
| 8583 | HCS and TxHmL Program Contact Information | ||
| 8583-S | HCS and TxHmL Program Contact Information (Spanish) | ||
| 8584 | Nursing Comprehensive Assessment | ||
| 8599 | Individual Plan of Care (IPC) Cover Sheet | ||
| 8600 | Individual Plan of Care (IPC) Backdating Cover Sheet | ||
| 8601 | Verification of Freedom of Choice | ||
| 8603 | Level of Need (LON) Review/Increase Cover Sheet | ||
| 8662 | Related Conditions Eligibility Screening Instrument | ||
| 8665 | Person-Directed Plan | ||
| 8665-DT | Person Directed Plan (PDP) Discovery Tool |