Forms · prints · exports

Every form HHSC wants. Column-aligned.

Sereniq renders every Texas HHSC form your state auditor expects, plus the internal documents your team uses to keep the agency running. State forms carry the Texas HHS lockup with a facsimile footer. Internal documents carry Sereniq branding so a reviewer can tell what’s what at a glance.

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HHSC state forms

Facsimile renderers, audit-grade.

Each form ships with explicit column geometry, the Texas HHS lockup, and a “Sereniq-generated facsimile of HHSC Form NNNN” footer. What you print is what your state auditor expects to see.

Form 4119
Service Delivery Log — HCS RSS daily / HCBS SL weekly
Form 4122
Service Delivery Log — HCBS Host Home / Companion Care, weekly
Form 3092
Medication Administration Record — monthly grid
Form 6900
Transportation log — per-trip print
Form 4719
Incident report — state format
Form 3608
Individual Plan of Care (IPC) — annual HCS authorization
Form 8665
Person-Directed Plan (PDP) — annual HCS
Form 3090 · 3091
Standard HCS/HCBS reference forms — nursing binder
Form 8002 · 8509 · 8585 · 8588 · 8621
Rights, eligibility, settings — binder packet
A facsimile, rendered

Form 4119 SDL — print-ready.

app.sereniqcare.com/reports/sdl/print
HCBS Service Delivery Log
Form 4119 · Sep 2020-E
Maple house · Houston, TX
Wk: Apr 22 – Apr 28, 2026
ActivitySunMonTueWedThuFriSat
Personal hygieneJRJRTCJRTCJRJR
Money handlingJRTCJR
Community accessJRTCJRJR
Meal prepJRJRTCJRTCJRJR
Health & safetyJRJRTCJRTCJRJR
Staff: J. Rivera (JR), T. Cole (TC)
Supervisor signature on file · 2026-04-29
Internal documents

The packets your team uses every day.

Client Binder

One-click state auditor packet — demographics, IRP/PDP, MAR, incidents, notes, consents

Nursing Binder

Delegation-focused — meds, allergies, vitals, controlled-meds counts

Demographic Sheet

Single-page ER / appointment snapshot

Evacuation Plan

Per-client emergency plan, posted in the home

Consent Packet

12 standard consents, agency-profile auto-filled

Controlled-Substance Count

Schedule II/III shift-end count log

Blood Sugar Log

Diabetic monitoring trend print

Fire-Drill Log

Per-drill print, state auditor-ready

Grocery List / Receipt

Per-request print for the shopper

Notes packet

Date-range, client, staff-filtered SDL packet

Agency Quarterly

HCBS quarterly upload artifact, AI-drafted

Incident Report (internal)

Full follow-up detail beyond the state form

Bundles & exports

One zip, everything in it.

Notes CSV export
Filterable, formula-leader neutralized for spreadsheet safety
HHSC Survey-Prep Bundle
Lists for the state auditor + deficiencies for the admin
Payroll Pay-Period Bundle
Timesheets + manual entries + summary, normalized to your pay-period config
See Sereniq in 20 minutes

Book a demo.

A live walk-through with your homes, your forms, and your questions. We’ll show you the mobile app, the Form 4119 print, and the six-month look-back export — then answer whatever your team needs to evaluate us.

  • 20-minute live walk-through
  • Built around your home count and programs
  • Migration support from Statewise, GIV, or paper
  • Custom pricing after the call
We reply within one business day