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Puc critical care fillable form 2026
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- Click ‘Get Form’ to open the Puc critical care fillable form in the editor.
- Begin by filling out Part 1 on Page 2. Enter your name as it appears on the electric account, followed by the patient's name and service address. Ensure all fields are completed accurately.
- Provide your ESI ID, which can be found on your electric bill. Circle the appropriate TDU based on the first seven digits of your ESI ID.
- Complete the contact information section, including primary and alternate phone numbers. Don’t forget to include an emergency contact name or indicate that you choose not to provide one.
- Sign and date the application at the bottom of Page 2, certifying that all information is correct.
- On Page 3, ensure that the patient’s physician fills out their section completely, including their signature and Texas Medical Board License Number.
- Once both pages are completed, submit them via fax or email to the appropriate TDU as indicated in the instructions.
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