Form h1003 2011-2025

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4.3 out of 5

367 votes

The document is a form from the Texas Health and Human Services Commission, titled 'Appointment of an Authorized Representative,' which allows individuals to designate someone to act on their behalf regarding Medicaid benefits. It outlines the necessary contact information, the relationship of the authorized representative, the duration of their authority, and the specific actions they can perform. The form requires signatures from both the client and the authorized representative, certifying the accuracy of the provided information.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (258 Votes)
2011	4.3 Satisfied (367 Votes)

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What is H1003 form?

Form H1003, Appointment of an Authorized Representative | Texas Health and Human Services.

Who is the authorized representative?

An authorized representative is an individual authorized under State or other applicable law to act on behalf of a beneficiary or other party involved in the appeal. Authorized representatives have all of the rights and responsibilities of a beneficiary or party, as applicable, throughout the appeals process.

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