Get Texas Vaccines For Children Program (tvfc): Provider ... - City Of Houston - Houstontx
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Texas Vaccines For Children Program (tvfc): Provider Enrollment form online
The Texas Vaccines For Children Program (tvfc) Provider Enrollment form is essential for healthcare providers looking to participate in the TVFC program. This guide offers clear, step-by-step instructions to help you complete the form accurately and efficiently, ensuring that you fulfill all necessary requirements.
Follow the steps to successfully complete the enrollment form.
- Press the ‘Get Form’ button to access the enrollment form and open it for editing.
- Begin by entering your Provider PIN number. If you do not have one, contact your Health Services Region (HSR) to obtain it.
- Provide the Provider Name, including Last Name, First Name, Middle Initial, and Title.
- Complete the Mailing Address section by entering the P.O. Box or Street Address, City, and Zip code.
- Enter the Telephone Number and ensure the Area Code is included. Provide the City, County, and Zip code as well.
- Provide an Email Address for correspondence regarding the enrollment.
- Ensure a licensed Medical Doctor, Doctor of Osteopathy, Nurse Practitioner, Physician Assistant, Registered Pharmacist, or Certified Nurse Midwife signs the form in the designated areas.
- Review the entire form for accuracy and completeness before proceeding.
Complete your enrollment process online today to ensure your facility can provide necessary vaccines to eligible children.
To claim an exclusion for reasons of conscience, including a religious belief, the child's parent, legal guardian, or a student 18 years of age or older must present to the school or child-care facility a completed, signed and notarized affidavit on a form provided by the department stating that the child's parent, ...
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.