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  • Tx Form 3054 2015

Get Tx Form 3054 2015-2026

Form 3054 July 2015-E Primary Home Care Service Delivery Record Month and Year of Service Provider Agency Name Vendor No. Employee Name/No. If more than one employee serves the individual, list employee.

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How to fill out the TX Form 3054 online

Filling out the TX Form 3054 is essential for documenting primary home care service delivery. This guide provides clear instructions to help users complete the form accurately and efficiently online.

Follow the steps to successfully complete the TX Form 3054 online.

  1. Press the ‘Get Form’ button to acquire the form and display it in your editing tool.
  2. Begin by entering the month and year of service at the top of the form. This is important for record-keeping.
  3. Input the provider agency name and vendor number in the designated fields to identify the service provider.
  4. Fill in the employee name and number, particularly if more than one employee is involved in providing the service.
  5. Enter the individual’s name and individual number to specify whom the services were provided for.
  6. Select the tasks assigned by ticking the appropriate boxes for each service provided, such as bathing, meal preparation, and others.
  7. Document the scheduled or authorized hours, providing both the 'In' and 'Out' times for each day of the week.
  8. Record the actual time spent on each service each day, following the specified format {Hours: Minutes AM/PM}.
  9. Total the hours worked each day and calculate the monthly total of hours at the bottom of the time record section.
  10. Finally, date the form to certify that you have accurately documented the hours worked and tasks completed.

Complete your TX Form 3054 online today and ensure accurate service delivery records.

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