Texas Health and Human Services Forms and Office Locations – Government Agency in Texas

21 - 40 of 366 forms

Form Title	Topics
Form 1091, First Dental Home Certification Application
Form 1099, Operational Discipline and Guidance Policy
Form 1123, Review of Assisted Living Facility Type C
Form 1141, PACE/SASO Registration Disenrollment
Form 1143, Cystic Fibrosis Treatment Products Authorization Request (CSHCN)
Form 1290, Long Term Care Claim
Form 1312, Growth Hormone Products Authorization Request (CSHCN)
Form 1315, Drug Shortage Notification
Form 1316, Pharmacy Electronic Remittance Advice Agreement
Form 1317, Pharmacy Eligibility Verification Portal Access Form
Form 1318, Medicaid Retroactive Claim
Form 1319, Pharmacy Claims Billing Request
Form 1321, Synagis Standard Prior Authorization Addendum (Medicaid)
Form 1325, Synagis Prior Authorization Addendum (CSHCN)
Form 1327, Growth Hormone Agents Standard PA Addendum (CSHCN)
Form 1329, Kidney Health Care Program Drug Rebate Agreement
Form 1335, Antiviral Agents for Hepatitis C Virus Initial Authorization Request (Medicaid)
Form 1338, Cystic Fibrosis Agents (Kalydeco/Orkambi/Symdeko) – Medicaid Standard PA Addendum
Form 1342, Antiviral Agents for Hepatitis C Virus Initial Request – Standard PA Addendum (Medicaid)
Form 1344, Managed Care Resources Update Request

Texas Health and Human Services