Are you ready to take the next step in ensuring your business is run smoothly and securely? A verification and checkup form can help. Verification forms are a great way to make sure that any person or item dealing with sensitive information meets the required safety standards of your company. In this post, we will discuss best practices for designing a verification form, as well as tips for achieving maximum effectiveness when utilizing one within your organization. Keep reading to learn more about these important steps!
| Question | Answer |
|---|---|
| Form Name | Verification Thsteps Checkup Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | verification checkup online, h1087, verification health checkup, tx steps thsteps |
Texas Health and Human Services Commission
Verification of Texas Health Steps (THSteps) Checkup
Form H1087
November 2007
From: Texas Works Advisor
Telephone No.
Fax No.
Date
Office Address
Fax to THSteps
From: THSteps Staff |
Telephone No. |
Fax No. |
Date |
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To: THSteps Regional Coordinator |
Telephone No. |
Fax No. |
Case Name
Case No.
Address
Telephone No.
This household is applying for assistance from the Texas Health and Human Services Commission. According to the TMHP paid claims system, the following child(ren) is (are) overdue:
1. Name of Child (Last, First, MI) |
Date of Birth |
Client No. |
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The caretaker states that this child |
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received a THSteps checkup from: |
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on |
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(provider's name and phone number) |
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(date) |
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Please provide additional information that could assist with the THSteps checkup verification: |
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Reply From THSteps Worker: (please sign below) |
THSteps Checkup Verified |
Client Initiated Contact |
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Comments: |
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2. Name of Child (Last, First, MI) |
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Date of Birth |
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Client No. |
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The caretaker states that this child |
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received a THSteps checkup from: |
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on |
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(provider's name and phone number) |
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(date) |
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Please provide additional information that could assist with the THSteps checkup verification: |
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Reply From THSteps Worker: (please sign below) |
THSteps Checkup Verified |
Client Initiated Contact |
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Comments: |
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Telephone No. |
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Signature – THSteps Worker |
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Date |
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I hereby give my permission to release the information requested on this form.
Por este medio doy permiso para divulgar la información que se pide en esta forma.
Signature – Parent/Firma – Padre o Madre |
Date/Fecha |