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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 4120
for the current year.
Form 4120 Day Habilitation Service Delivery Log - Texas
What Is Form 4120?
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 4120?
A: Form 4120 is the Day Habilitation Service Delivery Log used in Texas.
Q: What is Day Habilitation?
A: Day Habilitation is a service provided to individuals with disabilities to promote independence and community integration.
Q: What is the purpose of Form 4120?
A: The purpose of Form 4120 is to document the delivery of Day Habilitation services.
Q: Who uses Form 4120?
A: Form 4120 is used by providers of Day Habilitation services in Texas.
Q: What information is recorded on Form 4120?
A: Form 4120 records information such as the date, individual's name, services provided, and staff signatures.
Form Details:
- Released on November 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 4120 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.
Download Form 4120 Day Habilitation Service Delivery Log - Texas
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