Overview
Form 4123 is HHSC’s log for HCS nursing: the Registered Nurse, Specialized Registered Nurse, Licensed Vocational Nurse, and Specialized Licensed Vocational Nurse services. It lives on the HHSC forms site (current version May 2022). HHSC calls the form optional, but treats Form 4123, or any log made for the same purpose, as a Medicaid document. Most agencies still fill it in by hand after the visit, which is where the times, the units, and the medical need drift away from what happened.
Sereniq makes the visit the record. One log is one visit: one nurse, one individual, one type of nursing. On the phone, the nurse taps Start when the visit begins and Stop when it ends, ticks the activities, writes what they saw and did and why it was needed, and signs. On the web, the same log takes exact times. The same checks run in both places.
The print follows the Form 4123 layout and adds an Attachment to Form 4123 page for what the state form has no box for: the medical need, anything unusual, how the visit was given, the people served, and any late or correction details. It sits beside every HHSC form Sereniq prints. For the billing rules behind a nursing log, see our guide on HCS billing documentation.
Sereniq does not bill. Units are worked out and printed on the form for the nurse and the biller to read. There is no claim, no export to TMHP, and no EVV; Sereniq sits beside your billing as the documentation system of record.
What does HHSC Form 4123 record?
Form 4123 records one individual's nursing service events with one nurse: the individual's name and local case number, the nurse's staff ID, the date of service, the begin and end time of each event, the billable activities from the form's list, the total billable units for the day, and the signature of the nurse who gave the care. One form holds up to two service events.
| Field on the form | Where Sereniq gets it |
|---|---|
| Individual and local case number | The individual's record |
| Type of nursing | Picked on the log: RN, LVN, or the specialized RN or LVN service for an individual with a trach or a ventilator |
| Date, begin time, end time | The visit clock on the phone, or exact times typed on the web |
| Billable activities | The ticked activities, each tied to its Form 4123 row |
| Billable units | Worked out from the state table for the time per person |
| Signature and title | The nurse on the log signs; name and title (RN or LVN) are frozen at signing |
| Medical need and anything unusual | Written on the log, printed on the Attachment to Form 4123 |
What is the 14-day rule for Form 4123?
HHSC says Form 4123 must be completed within 14 calendar days after the activity it documents. Sereniq counts the days from the visit. A log written later can still be signed, with a warning on screen, and prints with a LATE stamp on its attachment page that says how many days late it was. A visit more than 120 days old cannot be signed at all.
Signed logs are locked. A mistake is fixed by writing a correction on the web, which prints beside the original, and the original is marked CORRECTED, so the record shows both. A nurse can void their own log within 24 hours of signing, with a reason; a voided log stays on the record and does not print.
Which Form 4123 activities can an LVN log, and which need an RN?
Sereniq ties each of its 22 plain-word activities to a Form 4123 row and to the nurse's license. Five are RN only: a health check by phone with advice or a referral, the comprehensive nursing assessment (CNA), writing or updating the CNA form, teaching or supervising staff on a delegated task, and supervising an LVN. One is LVN only: gathering information for the CNA form. The other 16 are open to both.
Each nurse only sees the two types of nursing their license allows, and the locked items show why (“RN only”). The clinical judgment stays with the nurse; our guide on whether DSPs can pass medications in Texas covers what an RN may delegate and what an LVN may not.
| Who can log it | Activities, as the nurse sees them |
|---|---|
| RN only | Health check by phone, with advice or a referral · Comprehensive nursing assessment (CNA) · Write or update the CNA form · Teach, supervise or check staff on a delegated task · Supervise an LVN |
| LVN only | Gather information for the CNA form |
| RN and LVN | The other 16, such as: give a medicine or treatment the doctor ordered · check pharmacy medicine against the order and the MAR · health check, face to face or by video · teach staff about this person (for example, choking risk) · talk with a pharmacist, insurer or SSA about medicine · help write the IPC or the implementation plan · annual nursing report |
Can a nurse log a phone or video visit on Form 4123?
Yes, for some activities. In Sereniq the nurse picks how the visit was given: in person, by video, or by phone. Activities that do not count that way are greyed out and tagged Not by phone or Not by video, so only what the visit could cover can be ticked. The attachment page prints how the visit was given.
HHSC’s HCS Billing Requirements say a video visit needs the individual’s consent recorded on the implementation plan. Sereniq reminds the nurse of that rule; it does not store the consent itself.
How are units of service worked out for an HCS nurse visit?
Sereniq works out the units from the visit's time per person, using the minutes-to-units table in HHSC's HCS Billing Requirements: 8 to 22 minutes is 0.25 units, 23 to 37 minutes is 0.50, and so on in quarter hours. When one nurse serves several people at once, the time is split across them first. Under 8 minutes per person is 0 units on that log.
Units show on screen while the nurse writes the log and print in the units box on Form 4123. A part of a minute is dropped, never rounded up, so the units never exceed the time the nurse wrote down. HHSC lets very short events count when added to the month’s other short events; that adding up is a billing step done outside Sereniq.
| Time per person | Units |
|---|---|
| Under 8 minutes | 0 on this log |
| 8 to 22 minutes | 0.25 |
| 23 to 37 minutes | 0.50 |
| 38 to 52 minutes | 0.75 |
| 53 to 67 minutes | 1.00 |
What does Sereniq check before a nurse signs a visit log?
Sereniq refuses a log that is word for word the nurse's last signed log for that individual, warns about vague words HHSC does not accept, warns when the type of nursing is not on the individual's current IPC, stamps a log written after 14 days as late, and will not sign a visit more than 120 days old. The phone shows Ready to sign once the checks pass.
| Check | What happens |
|---|---|
| Copied log | Refused when the log is word for word the nurse's last log for this individual |
| Vague words | Warning on phrases such as "had a good day", "same as above", "see previous", or ditto marks |
| Not on the IPC | Warning, never a block, when the type of nursing is not on the individual's current IPC |
| Late | Allowed after 14 days; prints with a LATE stamp |
| Too old | A visit more than 120 days ago cannot be signed |
| Overlap | Blocked when the times overlap another of the nurse's visits |
Do HCS providers have to use Form 4123?
No. HHSC calls Form 4123 an optional form. HHSC also says Form 4123, or another form created for a similar purpose, is a Medicaid document, so whatever log an agency uses must be accurate, and falsifying it is prohibited. Sereniq keeps the state layout anyway, because a surveyor who asks for the form gets the form.
What you get
- One log per visit: one nurse, one individual, one type of nursing
- Start and Stop on the phone fills the times; exact times on the web
- 22 plain-word activities, each tied to its Form 4123 row
- RN-only activities locked for LVNs; phone and video visits grey out what does not count
- Units of service worked out from the state table, split across the people served
- Copy, vague-words, IPC, and late checks before signing
- Signed logs locked; corrections print beside the original
- Prints as Form 4123 plus an Attachment to Form 4123 page
- Nurse time per individual each month, with No visit yet flagged
- Works offline on the phone, in English and Spanish
What agencies ask before switching.
Who signs Form 4123?
The nurse who gave the care during the billable activity, per HHSC's instructions. In Sereniq, the nurse on the log signs it, and their name and title (RN or LVN) are frozen at signing. If the nurse has drawn a signature in Sereniq, it prints on their signed logs.
How many visits fit on one Form 4123?
HHSC's form holds up to two separate service events. Sereniq keeps one log per visit and prints each visit on its own, or a whole month of one individual's logs at once.
Does Sereniq send nursing claims?
No. Units print on Form 4123 for the record. Sereniq does not create claims, export units, or connect to TMHP or EVV, and the nurse visit clock does not use GPS. Your billing stays where it is.
What does the nurse see on the phone?
My individuals: everyone in their homes, host homes included, grouped by home and tagged Draft to sign, No visit this month, or Last visit. The phone works offline and in English and Spanish. A signed log is read-only on the phone; corrections are written on the web.
Does Ask Sereniq know about nurse visits?
Yes. Ask Sereniq, the AI assistant included for every agency, answers questions such as who had no nurse visit this month from the visit counts, times, and units, and opens the Form 4123 print. It reads the record and does not write logs; a person reviews AI output before anything changes in the record.