Texas Works advisors use this form when a TANF or SNAP recipient says they cannot work because they must care for a disabled family member, or when TANF hardship exemptions are requested for that reason. The patient's physician states how much the caregiver can work or prepare for work and gives the family member's disabling diagnoses.
The patient's medical provider completes Section 2 (Part A caregiver work capacity and Part B diagnosis) and signs with license number. HHSC staff complete Section 1, and the patient or a personal representative signs the Section 3 release.
Download the current version from the source each time; forms change without notice.
Medical Release or 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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
The HHSC instructions name a physician, a physician assistant working under a physician's orders, an advanced practice nurse, a certified psychologist or a licensed osteopath. The provider completes Parts A and B of Section 2 and signs with printed name, date and license number.
If the caregiver can work only part time, the physician enters the hours per week they can work or take part in work activities, either outside the home or inside the home. Full-time capacity and inability to work are separate checkboxes.
Yes. HHSC posts a Spanish version, H1836-BS, on the same form page as the English H1836-B (June 2025). Both include the staff section, the physician section and the patient's authorization to release medical information.