10801
This Form is used for confirming departure from the Texas program.
This form is used for confirming the withdrawal of a document in the state of Texas.
This form is used for requesting informal dispute resolution in the state of Texas. It allows individuals to address and resolve issues without going to court.
This form is used for applying for the reallocation of Medicaid beds in Texas for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID).
This form is used for requesting a formal hearing in the state of Texas.
This form is used for adding additional details to an individual program plan in the state of Texas.
This form is used for conducting a pre-enrollment assessment in Texas.
This form is used for conducting a waiver survey and certification residential checklist in the state of Texas.
This form is used for applying for a community services contract in Texas.
This Form is used for applying to become an adult foster care provider in Texas. It is an addendum to the community services contract application and consists of a questionnaire.
This form is used for conducting fire marshal inspections in the state of Texas. It is used to document any violations or issues discovered during the inspection process.
This Form is used for recording the attendance of individuals in Day Activity and Health Services in Texas on a daily basis.
This Form is used for keeping track of daily transportation records in the state of Texas. It is used to document the details of transportation activities on a daily basis.
This Form is used for requesting adaptive AIDS, medical supplies, minor home modifications, or dental services/sedation in Texas.
This form is used for applying for a community services contract for emergency response services in Texas.
This form is used for applying for a community services contract in Texas.
This form is used for prospective owners in Texas to declare their intentions regarding Medicare certification.
This form is used to designate service areas within the state of Texas. It helps organizations determine the specific regions they will provide services in.
This Form is used for expressing intermediary preference in the state of Texas.
This form is used for designating the service area for programs such as HCS, TXHML, CDS, and TAS in the state of Texas.
This Form is used for transferring agreement in the state of Texas.
This Form is used for reporting fires that occur in long-term care facilities in Texas.
This form is used for applying for a state license to operate a Type C assisted living facility in Texas.
This Form is used for describing the process of selecting a representative sample in Texas. It provides information on how the sample is chosen and what criteria are used.
This form is used for notifying the Texas authorities of any adverse changes in your financial condition.
This form is used for requesting a waiver for room size in facilities in Texas.
This Form is used for notifying an adverse change in financial condition in the state of Texas.
This form is used for conducting a staffing review survey for ICF-IID facilities in Texas. It helps in evaluating the staffing needs and making necessary adjustments for the facilities.
This Form is used for summarizing and evaluating contracts in the state of Texas. It provides a concise summary of the key details and terms of the contract for easy reference and evaluation.
This form is used for reporting unit staffing information for Icf-Iid facilities in Texas.