PDF
Word
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 Provider Investigation Report?
A: Form 3613 Provider Investigation Report is a document used by Texas home health, hospice and personal assistance services providers for reporting provider investigations.
Q: What is the purpose of Form 3613 Provider Investigation Report?
A: The purpose of Form 3613 Provider Investigation Report is to document and report any investigations conducted by home health, hospice and personal assistance services providers in Texas.
Q: Who should use Form 3613 Provider Investigation Report?
A: Form 3613 Provider Investigation Report is only for use by home health, hospice and personal assistance services providers in Texas.
Q: Is a fax cover sheet required for Form 3613 Provider Investigation Report?
A: Yes, a fax cover sheet is required for submitting Form 3613 Provider Investigation Report.
Q: Can other types of providers use Form 3613 Provider Investigation Report?
A: No, Form 3613 Provider Investigation Report is specifically designed for home health, hospice and personal assistance services providers in Texas.
Form Details:
- Released on August 1, 2021;
- 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
1
2
3
