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Form 1024, Individual Status Summary

Medicaid No. Enter the individual’s Medicaid number.
CARE or Unique ID No. If the individual is enrolled in HCS, enter the individual’s Client Assignment and Registration (CARE) Identification number; if CARE has transitioned out of use, enter the Unique ID number assigned to the individual by Texas Medicaid & Healthcare Partnership (TMHP). Enter N/A if no CARE or Unique ID number exists.
Date of Birth Enter the individual’s date of birth using the mm/dd/yyyy format.
Service Area Enter the managed care service area the individual resides in. If the individual is not enrolled in HCBS, enter N/A. Link to service areas: https://hhs.texas.gov/sites/default/files//documents/services/health/medicaid-chip/programs/managed-care-service-areas-map.pdf ....

United States , Developmental Disability Authority , Care Organization , Medicaid Home Health , Service Coordinator Phone No , Waiver Program Provider , Service Coordinator Case , Waiver Program Provider Phone No , Health Services , Waiver Program Provider Representative , Program Manual , Resource Utilization Group , Community First Choice , Waiver Program , Community Based Services , Community Living Assistance , Service Area , Service Coordinator , Service Plan , Texas Medicaid Healthcare Partnership , Cost Of Services , Individual Service Plan , Individual Plan , Local Intellectual , Living Assistance , Support Services ,

Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC | Texas Health and Human Services

Enter the legal name of the LIDDA completing the form.
2. LIDDA Component Code
3. LIDDA Mailing Address
80. Managed Care Organization (MCO) or Department of State Health Services (DSHS) Name
Enter the name of the MCO chosen by the individual for CFC services or name of DSHS.
81. MCO Component Code
Enter the component code associated with the MCO chosen by the individual for CFC services. If DSHS, leave this field blank.
82. Plan Code
4. Individual’s Name (Last/First/Middle)
Enter the individual s last name, first name and middle name or initial.
10. Individual’s Date of Birth
Enter the individual s date of birth in MM-DD-YYYY format. ....

United States , Community First Choice , International Classification Of Diseases , Care Organization , Community Living Assistance , Department Of State Health Services , Texas Health , Leiter International Performance Scale , Agency Planning , Human Services Commission , Developmental Disabilities Authority , Related Conditions Assessment , Intermediate Care Facility , Intellectual Disability , Related Conditions , Developmental Disability , Waiver Programs , Support Services , Deaf Blind , Multiple Disabilities , Community Based Services , Texas Home Living , Local Intellectual , Client Assignment , Utilization Management , Waiver Eligibility ,