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Form 3619 Medicare / Skilled Nursing Facility Patient Transaction Notice - Texas
What Is Form 3619?
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 3619?
A: Form 3619 is the Medicare/Skilled Nursing Facility Patient Transaction Notice.
Q: What is the purpose of Form 3619?
A: The purpose of Form 3619 is to provide notice to patients in skilled nursing facilities regarding their financial responsibility for the services received.
Q: Who uses Form 3619?
A: Skilled nursing facilities in Texas use Form 3619 to notify patients.
Q: What information does Form 3619 include?
A: Form 3619 includes details about the patient's length of stay, daily co-payment amount, and charges for services.
Q: Is Form 3619 specific to Texas?
A: Yes, Form 3619 is specific to skilled nursing facilities in Texas.
Form Details:
- Released on July 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 3619 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.
