Get Form 1745

Filling out the Form 1745 is an essential task for individuals participating in consumer directed services. This guide will provide you with step-by-step instructions to ensure accurate completion of the form online.

Follow the steps to successfully complete your Form 1745 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the 'Program' section, select one of the options that applies to your service: CLASS, DBMD, CBA/STAR+PLUS WAIVER, HCS, MDCP, non-CBA/STAR+PLUS, PCS, PHC/FC/CAS, TxHmL, or PRIVATE PAY.
3. Enter the participant's name in the designated field, followed by the pay period details.
4. In the 'Service Type' section, check one of the boxes that correspond to the service provided, such as PAS, PAS/HAB, HABILITATION, PROTECTIVE SUPERVISION, LVN NURSING, RN NURSING, RESPITE, TRANSPORTATION, or specify another type in the provided space.
5. Fill in the service provider's name and the service date. You'll also need to provide the times for the service rendered, including time in and time out twice, noting whether these are AM or PM.
6. Calculate the total hours worked and fill in the 'Total Hours' field.
7. Indicate the place of service where the care was provided.
8. Provide a written narrative summarizing the service. If more space is needed, continue the narrative on the next page.
9. Certify the information provided by both the service provider and the employer or designated representative with their signatures and dates.
10. Review all entered information for accuracy, then save your changes, download, print, or share the form as needed.

Complete your Form 1745 online to ensure timely processing of your services.