Form 4121 is used by Texas Health and Human Services Commission (HHSC) staff, as well as Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver program providers to document a service event for the Community First Choice (CFC) Personal Assistance Services/Habilitation (PAS/HAB) service component.

Form 4121, Community First Choice Personal Assistance Services/Habilitation Author: Texas Health and Human Services Subject: Form 4121, Community First Choice Personal Assistance Services/Habilitation Created Date: 4/12/2019 10:48:33 AM

The purpose of this section is to make the most current forms available with a single resource. Forms are used to collect information and remain in the handbook until the form is no longer necessary. ES = Spanish version available.

Form 4121 is a documentation template used for recording services provided under Home and Community-based Services in Texas, specifically for Community First Choice Personal Assistance Services and Habilitation.

Complete TX Form 4121 2022-2025 online with US Legal Forms. Easily fill out PDF blank, edit, and sign them. Save or instantly send your ready documents.

Complete Form 4121 online with US Legal Forms. Easily fill out PDF blank, edit, and sign them. Save or instantly send your ready documents.

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