Form H3676, Managed Care Pre-Enrollment Assessment Authorization

Disability Prevention for Children, Office of (ODPC)

This government document is issued by Disability Prevention for Children, Office of (ODPC) for use in Texas

Add to Favorites
File Details: PDF (233 KB)
Source
https://www.hhs.texas.gov/regulations/forms/3000-3999/form-h3676-managed-care-pre-enrollment-assessment-authorization

Have Questions About This Form?
Ask An Expert For Help:

Questions and comments are moderated. Minimum of 10 characters.

All questions and comments are moderated and publicly viewable. Please do not post private or sensitive information such as names, addresses, phone numbers, emails, confidential financial and legal details.

Login or sign up to submit questions