Texas Home Living (TxHmL) Program
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 | ||
| 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 | ||
| 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) | ||
| 1592 | RN Delegation Checklist | ||
| 1740 | Service Backup Plan | ||
| 1741 | Corrective Action Plan | ||
| 1741-S | Corrective Action Plan (Spanish) | ||
| 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 | ||
| 4117 | Supported Employment/Employment Assistance Service Delivery Log | ||
| 4118 | Respite Service Delivery Log | ||
| 4120 | Day Habilitation Service Delivery Log | ||
| 5608 | Waiver Survey and Certification TxHmL DFPS Checklist | ||
| 5612 | TxHmL Personnel Checklist | ||
| 5842 | TxHmL Financial Eligibility Information | ||
| 8493 | Notification to DADS Regarding a Death in HCS, TxHmL and DBMD Programs | ||
| 8494 | Notification to DADS Regarding DFPS Investigation | ||
| 8572 | TxHmL Individual Profile Information | ||
| 8575 | Notification of Local Authority (LA) Reassignment | ||
| 8578 | Intellectual Disability/Related Condition Assessment | ||
| 8580 | Request for Variance of Supported Employment - Employer Requirements | ||
| 8581 | Corrective Action Plan Form | ||
| 8582 | Individual Plan of Care - TxHmL | ||
| 8583 | HCS and TxHmL Program Contact Information | ||
| 8583-S | HCS and TxHmL Program Contact Information (Spanish) | ||
| 8584 | Nursing Comprehensive Assessment | ||
| 8586 | TxHmL Service Coordination Notification | ||
| 8586-S | TxHmL Service Coordination Notification (Spanish) | ||
| 8599 | Individual Plan of Care (IPC) Cover Sheet | ||
| 8600 | Individual Plan of Care (IPC) Backdating Cover Sheet | ||
| 8601 | Verification of Freedom of Choice | ||
| 8608 | Sample Appeal Letter | ||
| 8627 | Request for Review of Individual Plan of Care (IPC) Cost Over Maximum Cost Ceiling Cover Sheet | ||
| 8628 | Request to Increase in Service Category Limits Worksheet | ||
| 8662 | Related Conditions Eligibility Screening Instrument |