Form 4122 is used by Texas Health and Human Services Commission (HHSC) staff and Home and Community-based Services (HCS) Waiver program providers to document a service event for the …

Home and Community-based ServicesHost Home/Companion Care Service Delivery Log

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Download Form 4122, Host Home/Companion Care Service Delivery Log – Texas Health and Human Services (Texas) form

The electronic application intake system, Medicare Electronic Application Request Information System (MEARISTM), is available for Section 4122 application submissions, with application submissions for …

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Obtain a copy of TX Form 4122 from the Texas Department of Health website or your local health department. Read the instructions that accompany the form carefully. Fill out the identifying …

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Filling out the TX Form 4122 is an essential step in documenting the delivery of home and community-based services. This guide provides clear and succinct instructions on completing the form online, …