WebTexas Health and Human Services Commission Emergency Medical Services Certification Form H3038 July 2012 Name of Patient Date of Birth Case Name (if different) Case No. TO THE PATIENT’S ATTENDING PRACTITIONER (or other Practitioner familiar with this patient’s case): The Texas Health and Human Services Commission (HHSC) …
Form 3052, Practitioner
Form 3052 is completed for initial referrals for PHC and CAS, and for referrals for people whose initial medical need for services was temporary. If a person began services based on a temporary need and the need becomes ongoing, a new Form 3052 is required. The PHC or CAS HCSSA may complete Form … See more To be used by the following to request a statement of medical need from the person’s practitioner: 1. Primary Home Care (PHC) and Community Attendant Services (CAS) … See more The HCSSA or employer must complete Part I, Person’s Information. Name— Enter the person’s full name as it appears on Form 2101, Authorization for Community Care Services. Individual No.— Enter the … See more The HCSSA: 1. Completes Part I, Person’s Information, and Part II, HCSSA’s or Financial Management Services Agency’s … See more CCSE staff or the regional nurse must keep Form 3052 in the person’s file as part of the case record for three years and 90 days after the case is closed. The HCSSA retains a copy of the … See more Web01. Edit your 3052 form online Type text, add images, blackout confidential details, add comments, highlights and more. 02. Sign it in a few clicks Draw your signature, type it, … led scanner alarm
Form 3254 - Contracts
WebHHSC manages programs that help families with food, health care, safety, and disaster services including the Women, Infants, and Children (WIC), Children’s Medicaid, and Supplemental Nutritional Assistance (SNAP) programs. Texas Health and Human Services Commission HHSC offers the following programs: WebForm 3254 Page 2/11-2024-E III. General Requirements The Contractor hereby agrees: III.1 In General A. To provide all services in the Contract Type and in the Service Area, specified in Section I of this Contract. ... To comply with the following documents promulgated by HHSC: 1. applicable provider manuals or handbooks; 2. applicable billing ... WebEnter your official identification and contact details. Use a check mark to indicate the answer where required. Double check all the fillable fields to ensure total precision. Use the Sign Tool to create and add your electronic signature to signNow the DADS or HHSC Form — The Texas Department of Aging and ... — dads state TX. how to enroll as a provider