Texas Form 1745 PDF Details

In the realm of healthcare and assistance services within Texas, the introduction of the Texas 1745 form marks a significant step in streamlining the documentation and verification of services provided under Consumer Directed Services. Sponsored by the Alamo Consumer Direct in liaison with the Texas Department of Aging and Disability Services, this detailed form serves as a critical tool for both employees and consumers engaged in various programs such as DBMD (Deaf Blind with Multiple Disabilities), CBA (Community Based Alternatives), CLASS (Community Living Assistance and Support Services), HCS (Home and Community-based Services), PCS (Primary Home Care), PHC (Personal Home Care), and TXHML (Texas Home Living). Designed to meticulously record service dates, times, and descriptions, the form also includes a provision for both employee and consumer signatures to certify the accuracy of the recorded hours and the compliance of services with the Employee Work Schedule and Assigned Tasks (DADS 1731). Additionally, it emphasizes the legal consequences of falsifying time sheets, underscoring the seriousness with which Medicaid fraud is treated. This documentation process, with its clear structure for recording and certifying service delivery, not only facilitates the efficient management of services but also aids in ensuring transparency and accountability in the provision of care, thereby safeguarding the interests of both providers and recipients within Texas's healthcare framework.

QuestionAnswer
Form NameTexas Form 1745
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesDBMDCBAC, Fraudandmayresultind, CheckProgram, ServiceDate

Form Preview Example

Alamo Consumer Direct

Consumer Directed Services

Texas Department of Aging

Phone: 5124200832, Toll Free: 18779030832

Service Delivery Log with Written

and Disability Services

Toll Free Fax: 18776520877

Narrative/Written Summary

Form 1745compliant

8701 Shoal Creek Blvd, Suite 303

 

 

Austin TX 787576809

 

 

Employee Name

Consumer Name

Time sheet due date: If faxed or dropped off, time sheets are due at the Consumer Direct office by Monday (at midnight) following the week of service. If mailed, they must be postmarked by Monday following the week of service. Late time sheets will result in late pay.

Check Program: DBMD CBA CLASS HCS PCS PHC TXHML

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Service Date

(mm/dd/yy)

Service Code

Time In

Time Out

Time In

Time Out

Time In

Time Out

Daily Total

NOTE: Time sheets must be signed AFTER the work is completed. Advance time sheets will not be accepted. Total Weekly Hours

Service Date

(mm/dd/yy)

Place of Service

Written Narrative/Summary

Employee/Consumer: I certify that the work hours listed above are accurate, and that services were provided in accordance with the Employee Work Schedule and Assigned Tasks (DADS 1731). I understand that falsification of this time sheet is considered Medicaid Fraud and may result in dismissal from the program and criminal prosecution.

Employee Signature

Date

Consumer Signature

Date

02052

REV. 06/27/2013

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Simple tips to fill in CheckProgram part 1

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Stage # 2 of completing CheckProgram

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