Texas Medicaid Form 3074
Hospice Forms Texas
(1) The signature and title of each licensed nurse or healthcare professional completing any section of the MDS assessment forMedicaid reimbursement; and(2) The section(s) and completion date(s) corresponding tothe signature of the nurse or health care professional.(e) Each individual signing the signature section on the BasicTracking Form is certifying that the information entered on the MDSassessment is accurate.