Follow the steps to successfully fill out the Texan Plus form online.

1. Press the ‘Get Form’ button to access the Texan Plus form and open it in your preferred online editor.
2. Begin by filling in the patient’s name in the designated field. Ensure the name is written clearly as it appears on legal documents.
3. Next, enter the date of birth (DOB) in the specified format. Double-check for accuracy to avoid any processing delays.
4. Provide the member ID number as assigned, which is crucial for identification within the system.
5. List the primary care provider (PCP) in the designated field, ensuring to include their full name.
6. Select the referral type by checking the appropriate box, indicating whether the request is for routine or expedited services.
7. In the next section, mark the specific services required by checking all relevant options, such as outpatient surgery or home health.
8. Fill in the details regarding the referring physician, including name, address, and contact information.
9. Input the requested provider or facility name along with their address, ensuring all details are correct.
10. Specify the primary and any secondary diagnoses in the respective fields, using the appropriate coding system where required.
11. Finally, review all entered information for accuracy. Once confirmed, you can save changes, download the completed form, or print and share it as needed.

Take action now to fill out your documents online!