Protective Devices Assessment


Protective Devices Assessment-Sample form to assist with meeting HCS Medicaid-Waiver Compliance TAC Code 565.37.  Please contact us at if you have any issues with downloading the product.



Texas Administrative Code 565.37Protective Devices– discusses the need for individuals in the HCS program to have an assessment completed by a physician, PT, OT, or RN, if there is a need identified for the individual to wear/use a “protective device”.  They must conduct an initial assessment to determine the type of protective device, the medical need along with other factors,  This should also be completed annually thereafter or after a significant change. The device must not be used for modifying behaviors, disciplinary reasons, for staff convenience, or as a substitute for a less restrictive but effective method. We have provided a sample assessment that meets the criteria surveyors will expect to see.  The HCS provider should maintain this assessment in the client record.







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