Hhsc form 7484-2026

1. Click ‘Get Form’ to open the HHSC Form 7484 in the editor.
2. Begin by entering the mother's name in the designated field, ensuring you include her last name, first name, and middle initial if applicable.
3. Fill in the admission date of the mother using the mm/dd/yy format. This is crucial for accurate record-keeping.
4. Complete the mother’s mailing address, including street, city, state, and ZIP code. This information is essential for future correspondence.
5. Input the mother’s date of birth and Medicaid recipient number. Ensure accuracy to avoid delays in processing.
6. For each child born, enter their last name, first name, middle initial (if known), sex (M/F), and date of birth. If a child's first name is unknown, provide their last name only.
7. Indicate whether the mother has relinquished her rights to the newborn child by selecting 'Yes' or 'No' and provide the date if applicable.
8. Fill in details about the attending physician and hospital information as required. Ensure all fields are completed accurately.
9. Once all sections are filled out correctly, review your entries for any errors before submitting.

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