Get Form 300.doc - Dshs State Tx

Filling out the Form 300 for the County Indigent Health Care Program is a straightforward process that requires accurate information about services provided over the course of the state fiscal year. This guide will provide you with clear instructions to successfully complete the form online.

Follow the steps to efficiently complete the Form 300 online.

1. Click the 'Get Form' button to access the online version of Form 300. This will enable you to open the document in an editor for completion.
2. Begin by entering the state fiscal year in the designated space at the top of the form. This period typically runs from September 1 to August 31.
3. Provide the name of your entity in the 'Entity Name' field. This may include options like county, public hospital, or hospital district; ensure that you check the appropriate box below this section to indicate your entity type.
4. For section I, calculate the total number of unduplicated clients served over the fiscal year. Remember not to count the same individual more than once. Additionally, specify the number of these clients that are SSI appellants.
5. In section II, break down the total expenditures into various categories as indicated on the form. Fill in the dollar amounts for each category, including physician services, prescription drugs, and various hospital services.
6. Proceed to section III, where you will list the five top diagnoses of your clients. Be sure to provide clear and accurate descriptions for each diagnosis.
7. For section IV, indicate the percentage of the federal poverty guideline used to determine eligibility for the services provided.
8. Finally, include the signature of the person submitting Form 300, along with their telephone number and the date of submission.
9. Review all entered information for accuracy. After confirming that all fields are complete, you can save your changes, download the file, print it out, or share it as necessary.

Complete your Form 300 online today and ensure timely submission for the County Indigent Health Care Program.