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This version of the form is not currently in use and is provided for reference only. Download this version of
Form 3613
for the current year.
Form 3613 Provider Investigation Report With Fax Cover Sheet (Home Health, Hospice and Personal Assistance Services Provider Use Only) - Texas
What Is Form 3613?
This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 3613?
A: Form 3613 is a Provider Investigation Report with Fax Cover Sheet specifically for Home Health, Hospice, and Personal Assistance Services providers in Texas.
Q: Who can use Form 3613?
A: Only Home Health, Hospice, and Personal Assistance Services providers in Texas can use Form 3613.
Q: What is the purpose of Form 3613?
A: The purpose of Form 3613 is to report and investigate any issues or concerns related to the provider's services.
Q: Is Form 3613 required to be faxed?
A: Yes, Form 3613 needs to be faxed along with any supporting documents or evidence.
Q: Can providers from other states use Form 3613?
A: No, Form 3613 is specifically for providers in Texas and may not be applicable for providers in other states.
Form Details:
- Released on May 1, 2018;
- The latest edition provided by the Texas Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form 3613 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.
Download Form 3613 Provider Investigation Report With Fax Cover Sheet (Home Health, Hospice and Personal Assistance Services Provider Use Only) - Texas
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