Texas Works advisors prepare this two-page form when a SNAP recipient who appears able to work claims a disability, or when a TANF recipient claims a disability affecting work or seeks a hardship exemption. The physician states whether the person can work or take part in work-preparation activities full time, part time, with restrictions or not at all. HHSC uses it to verify the disability, and the local workforce board uses it to plan activities.
HHSC staff complete Section I with the patient's details, usual job and the return office. A physician, physician assistant under a physician's orders, advanced practice nurse, certified psychologist or licensed osteopath completes Section II, and the patient or personal representative signs the Section III release.
The Texas Works advisor enters the patient's name, date of birth and Social Security number, the case name (caregiver) and case number, the patient's usual job, and the HHSC office address, mail code and fax number. Section II opens by explaining that federal and state rules require benefit recipients to work or prepare for work unless physically or mentally incapable, and that the patient claims that disability.
Check one box. Option 1: able to work or prepare for work without restrictions, full time (40 hours a week) or part time at a stated number of hours. Option 2: able with restrictions, full or part time, and then complete Parts B and C. Option 3: unable to work or prepare for work at all, and say whether the disability is permanent, not permanent but expected to last more than 6 months, or 6 months or less.
For each activity, check the maximum hours per workday (2, 4, 6, 8 or other): sitting, standing, walking, climbing stairs or ladders, kneeling or squatting, bending or stooping, pushing or pulling, keyboarding, lifting or carrying, and other. Give the weight limit for lifting or carrying and the hours per day. Then answer whether the person can do low-strain office work or classroom activities, and add remarks, recommendations or restrictions.
Enter the primary and secondary disabling diagnoses and any comments. Type or print your name, sign and date, and give your license number, office address and phone. HHSC's instructions say the provider must sign, date and return the form to the local eligibility determination office.
The patient names the doctor, facility or other provider authorized to complete the form and release the information to HHSC and the Texas Workforce Commission, sets an expiration date, and signs. A personal representative signing for the patient describes their authority to act. If the patient signs by mark, two witnesses sign and date. The notice explains that HHSC protects the information and that permission can be withdrawn in writing.
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Medical Release/Physician's Statement
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Sources for this guide
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HHSC's instructions say the individual takes the form to a physician, physician assistant working under a physician's orders, advanced practice nurse, certified psychologist or licensed osteopath. The provider completes Section II, signs and dates it, and adds a license number, office address and phone in Part C.
Not to be eligible for TANF, SNAP or Medicaid. The patient must sign the Section III authorization, however, to be considered for an exemption from the employment services program. It lets the named provider release information to HHSC and the Texas Workforce Commission until the stated expiration date, and can be withdrawn in writing.
Part B tells you that people with employment limitations may still be assigned community work in an office with little physical strain, such as answering phones or filing while seated, or employment-related activities in a classroom. It asks whether, in your opinion, the person can take part in activities like these. Answer Yes or No and add remarks or restrictions.
Yes. HHSC's form page lists a Spanish version, H1836-AS, alongside the English PDF. The physician's questions and the release are the same, and the completed form goes to the same HHSC office.