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Form 3616 Request for Termination of Services Provided by Hcs / Txhml Waiver Provider - Texas
What Is Form 3616?
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 3616?
A: Form 3616 is a request for termination of services provided by HCS/TxHmL waiver provider in Texas.
Q: Who can submit Form 3616?
A: The form can be submitted by the individual receiving services or their authorized representative.
Q: Why would someone submit Form 3616?
A: Form 3616 is submitted to request termination of services provided by HCS/TxHmL waiver provider.
Q: What information is required in Form 3616?
A: Form 3616 requires information such as the individual's name, provider information, reason for termination, and authorization signature.
Q: Is there a deadline for submitting Form 3616?
A: There is no specific deadline mentioned for submitting Form 3616. However, it is advisable to submit the form as soon as possible after the decision to terminate services has been made.
Q: Can I cancel or withdraw my Form 3616 after submission?
A: Yes, you can cancel or withdraw your Form 3616 after submission by contacting the HCS/TxHmL waiver provider or the Texas Health and Human Services Commission.
Q: What happens after submitting Form 3616?
A: After submitting Form 3616, the HCS/TxHmL waiver provider will review the request and make a decision regarding the termination of services.
Form Details:
- Released on May 1, 2015;
- 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 3616 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.
