Blank 2101 Texas PDF Form

The Texas Department of Aging and Disability Services has developed the Form 2101, a crucial document that facilitates the authorization of community care services. This form is designed to capture essential information about the services being requested, including the service name, contract number, and the type of authorization—whether it is a new request, an update, or a termination. Key details such as the individual's name and number, the 2060 score, and the specific dates for service initiation and termination are also included. The form outlines various service copayment structures and specifies the funding codes, unit types, and amounts associated with the care services. Furthermore, it allows for the identification of personal assistance services, enabling case managers to check off specific tasks like bathing, grooming, and meal preparation that may be necessary for the individual receiving care. The inclusion of authorizing agents, along with their contact information, ensures that all parties involved in the care process are properly documented. This comprehensive approach not only streamlines the authorization process but also enhances communication among agencies, practitioners, and caregivers, ultimately improving service delivery for individuals in need of assistance.