Tp2 form 2022-2026

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The document is a Request for Extension of Outpatient Therapy (Form TP-2) used by the Texas Medicaid & Healthcare Partnership. It collects essential information about the client, including personal details, therapy history, diagnosis codes, and requested therapy services. The form requires signatures from relevant healthcare providers and outlines the need for continued therapy based on prior treatment and functional status.

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Click ‘Get Form’ to open the tp2 form 2022 in the editor.
Begin by entering the Medicaid Number and CSHCN Number at the top of the form. This information is crucial for processing your request.
Fill in the Client Name, Date of Birth, and Telephone number. Ensure accuracy as this data is essential for identification.
Indicate whether the child has received therapy from the public school system in the last year by checking 'Yes' or 'No'.
Complete the section regarding therapy details, including ICD-9 Code/Diagnosis and Date of Onset. Select the Category of Therapy Being Requested by checking appropriate boxes.
In the Service Requested section, specify dates of service and frequency per week or month. Remember that service dates cannot exceed six months.
Finally, ensure all required signatures are obtained from specialists and therapists before submitting your form.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (75 Votes)
2007	4 Satisfied (26 Votes)

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