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Get Hhsc Form 7484
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How to fill out the HHSC Form 7484 online
This guide provides a clear and user-friendly approach to completing the HHSC Form 7484, which is used to report the birth of a child to the Texas Health and Human Services Commission. Follow these steps to ensure a smooth submission process for the required documentation.
Follow the steps to complete your HHSC Form 7484 online.
- Press the ‘Get Form’ button to download the form and open it in your preferred online editor.
- Begin by entering the mother’s information. Fill in her name, admission date, mailing address, date of birth, Medicaid recipient number, and medical record number accurately to prevent any delays.
- Proceed to the child’s details. You can input the child's last name, first name, sex, date of birth, and medical record number for each child. If the first name is unknown, you may complete the last name field.
- Indicate whether the mother has relinquished her rights to the newborn child by selecting 'Yes' or 'No'. If you select 'Yes', please provide the date of relinquishment.
- Enter the attending physician's information along with their medical license number. Make sure to include the name of the hospital and its address.
- Finally, complete the section for who filled out the form and provide the hospital’s telephone number. Also, indicate the date the form is being mailed.
- Review all the entered information for accuracy. Once confirmed, save your changes, and choose to download, print, or share the completed form as needed.
Complete your HHSC Form 7484 online today to ensure timely processing of your newborn's Medicaid claims.
Related links form
To fill out a mail forwarding form, start by entering the current address and the new forwarding address. Ensure you comply with all instructions listed in the Hhsc Form 7484 to avoid delays in your mail delivery. Finally, confirm that all information is accurate before submitting the form.
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