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  • Texas Referral Authorization Form .pdf - Parkland Community ...

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Texas Referral/Authorization Form Please fill out form completely in blue or black ink. Refer to instruction sheet. This referral does not guarantee payment. Please contact health plan to verify member.

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Charity Discount Policy. Parkland Medical Center has a Financial Assistance Policy that provides free hospital care for patients who have received non-elective care, do not meet the qualifications for Medicaid and whose income is less than 200% (in most cases) of the Federal Poverty Level.

Our service area covers Dallas, Collin, Ellis, Hunt, Kaufman, Navarro, and Rockwall counties, where members can seek care at more than 6,000 doctors and specialists and over 40 hospitals and urgent care centers.

Licensed for 983 beds, Parkland is Dallas County's only public hospital and one of the country's largest. Just minutes northwest of downtown Dallas on Harry Hines Boulevard, Parkland is home to a Level 1 Trauma Center and a Burn Center, both of which are internationally recognized.

People can receive care in one of Parkland's 16 health centers, 5 school-based clinics and other locations across Dallas County. Our network provides many health services, including check-ups, sick visits and acute care.

Except for emergency services, post-stabilization services, and services provided to you during an approved inpatient admission, all services from an out-of-network provider must be prior authorized. Claims for services from out-of-network providers that are not approved before the service is given may be denied.

Parkland requires proof of: That you live in Dallas County (residency) Valid photo identification (ID) Income.

If you think more information or an additional form may be needed, please check the issuer's website before faxing or mailing your request. Please fax form to Superior HealthPlan at 1-866-399-0929.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232