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Form 3054, Primary Home Care Service Delivery Record, or an alternate form of documentation, must be used to document service delivery. The alternate form must include all the required elements to be in compliance with the rules of the Primary Home Care (PHC) Program.
3054: Primary Home Care Service Delivery Record ES: 3055: Physician's Orders (DAHS) 3062: DAHS Utilization Review Report: 3070: Day Activity and Health Services Notification of Critical Omissions: 3071: Individual Election, Cancellation or Update ES: 3074: Physician Certification of Terminal Illness ES: 3251
Forms Contracting to Provide Primary Home Care Services. Left Menu. Subchapter A, Introduction; Subchapter B, Provider Agency Contracts ... Form Title; 3054: Primary Home Care Service Delivery Record ES: 211 Texas; Apply for Benefits; Compact with Texans; Department of State Health Services; Email Encryption; File Viewing;
The Texas Health and Human Services Commission (HHS) implemented standards for day activity and health services (DAHS) providers on Sept. 1, 2017. Both forms should be faxed to 877-940-1972. Detailed instructions and additional information for each form are online at hhs.texas.gov > Regulations > Forms. Questions?
Fill and download the Form 3054 Primary Home Care Service Delivery Record - Texas online in PDF format. Easily edit and print the form or save it as a ready-to-use PDF document.
20 gru 2020 · The applications and forms listed below are available in the HHS Enterprise Portal. This page was last updated December 20, 2021.
29 sty 2024 · Also called DD Form 3054, this standardized planning tool is a living document to be updated as your family’s needs change. It is available across the services to provide your family-focused and consistent EFMP family support, regardless of where the military may take you.
