In order to ensure accurate and consistent reporting, the Texas Department of State Health Services (DSHS) requires that all local health departments use Form Di 625 when submitting reports on births and fetal deaths. This form can be downloaded from the DSHS website, and must be completed in full before submission. The information collected on Form Di 625 is used to track birth and fetal death rates in Texas, as well as to identify potential causes of adverse outcomes. Completing this form accurately is therefore critical for helping DSHS protect the health of Texans.
| Question | Answer |
|---|---|
| Form Name | Form Di 625 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | OPF, fillable di 625, form di 625, GPO |
POSITION CLASSIFICATION AMENDMENT
1. OFFICIAL HEADQUARTERS
2. NAME OF INCUMBENT
3. ORGANIZATIONAL LOCATION
AS SHOWN ON CURRENT DESCRIPTION;
AS HEREBY AMENDED
11a.d.
b.e.
c.
4. CSC TITLE AND BUREAU POSITION NO.
SCHEDULE
SERIES
GRADE
SAME AS PRESENT; AMENDED FOR:
CSC TITLE,
POS. NO.,
SCHEDULE,
SERIES,
GRADE
CERTIFICATIONS
5.I certify that this is an accurate statement of the major duties and responsibilities of this position and its organizational relationships, and that the position is necessary to carry out government functions for which I am responsible. This certification is made with the knowledge that this information is to be used for statutory purposes relating to appointment and payment of public funds, and that false or misleading statements may constitute violations of such statues or their implementing regulations.
(Signature of IMMEDIATE Supervisor) |
|
Title |
Date |
6.I CERTIFY THAT THE CHANGES REFLECTED ARE PROPER AND THE POSITION AS HEREBY AMENDED IS PROPERLY CLASSIFIED.
(Signature of Official Exercising Classification Authority) |
(Date) |
TITLE
7. DESCRIBE BRIEFLY, BUT IN FULL, THE REASONS FOR CHANGES CHECKED ABOVE, AND THE ADDITIONS, DELETIONS, OR OTHER REVISIONS WHICH ARE TO BE MADE IN THE
DESCRIPTION PROPER.
GPO
DISTRIBUTION:
Classification Copy
Supervisor's Copy
Employee's Copy
OPF Copy
This form was electronically produced by Elite Federal Forms, Inc.