Intake packet - Texana Center 2026

1. Click ‘Get Form’ to open the Intake packet in the editor.
2. Begin by filling in your Case Number at the top of the form. This helps in tracking your application.
3. Enter the Applicant’s Name, Social Security Number, Date of Birth, and Age in the designated fields. Ensure accuracy for proper identification.
4. Provide the Address and contact information, including Telephone and Alternate Telephone numbers for communication purposes.
5. Indicate the Applicant's Sex by selecting either Female or Male using the checkboxes provided.
6. Fill in Medicaid Number and indicate if you are enrolled in Star Plus by checking Yes or No.
7. In the Referral Information section, complete details about who is completing the assessment and their relationship to the applicant.
8. Select any services you are seeking assistance with from the list provided. Make sure to check all that apply.

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