The Texas 1745 form is a Service Delivery Log used in the Consumer Directed Services program managed by the Texas Department of Aging. This form is essential for documenting the hours worked by employees providing care to consumers, ensuring accurate tracking and compliance with state regulations. Timely submission is crucial, as late time sheets can lead to delayed payments.
The Texas 1745 form serves as a critical tool for managing the delivery of consumer-directed services within the state's aging and disability programs. This form is primarily used for documenting service delivery logs, ensuring that employees accurately report their hours worked and the services provided to consumers. Each entry requires detailed information, including service dates, codes, and time in and out, to maintain transparency and accountability. Timeliness is essential; time sheets must be submitted by specific deadlines to avoid delays in payment. The form also includes a certification section where both the employee and consumer affirm the accuracy of the reported hours, underscoring the importance of honesty in the process. Failure to comply with these requirements can lead to serious consequences, including the risk of Medicaid fraud allegations. As such, understanding the nuances of the Texas 1745 form is vital for both employees and consumers to navigate the complexities of service delivery effectively.
Alamo Consumer Direct
Consumer Directed Services
Texas Department of Aging
Phone: 512‐420‐0832, Toll Free: 1‐877‐903‐0832
Service Delivery Log with Written
and Disability Services
Toll Free Fax: 1‐877‐652‐0877
Narrative/Written Summary
Form 1745‐compliant
8701 Shoal Creek Blvd, Suite 303
Austin TX 78757‐6809
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
Daily Total
NOTE: Time sheets must be signed AFTER the work is completed. Advance time sheets will not be accepted. Total Weekly Hours
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
02052
REV. 06/27/2013
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