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How to use or fill out Intake packet - Texana Center with our platform
- Click ‘Get Form’ to open the Intake packet in the editor.
- Begin by filling in your Case Number at the top of the form. This helps in tracking your application.
- Enter the Applicant’s Name, Social Security Number, Date of Birth, and Age in the designated fields. Ensure accuracy for proper identification.
- Provide the Address and contact information, including Telephone and Alternate Telephone numbers for communication purposes.
- Indicate the Applicant's Sex by selecting either Female or Male using the checkboxes provided.
- Fill in Medicaid Number and indicate if you are enrolled in Star Plus by checking Yes or No.
- In the Referral Information section, complete details about who is completing the assessment and their relationship to the applicant.
- Select any services you are seeking assistance with from the list provided. Make sure to check all that apply.
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See more Intake packet - Texana Center versions
| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2020 | 4.8 Satisfied (80 Votes) |
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