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The document is a certification form (Form H3038) from the Texas Health and Human Services Commission for emergency medical services coverage under Medicaid. It requires the attending practitioner to certify that a patient experienced an emergency medical condition, detailing the dates of treatment and nature of the condition. The form also includes an authorization section for the patient to allow HHSC to access their medical information to determine eligibility for services.

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h3038

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What is the form H1019 for Texas HHSC?

Purpose. To provide clients a form that lists their reporting requirements. To provide clients a form to report changes in their circumstances. To provide Texas Health and Human Services Commission (HHSC) office staff a form to record information reported by clients about changes in their circumstances.

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What is the form H1019 for Texas HHSC?

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