Get (tvfc) Program Patient Eligibility Screening Record - Texas Children's ...

The Texas Vaccines for Children (TVFC) Program Patient Eligibility Screening Record is essential for children eligible for immunizations under the TVFC Program. This guide provides step-by-step instructions to help you fill out the form online accurately.

Follow the steps to complete the eligibility screening record online.

1. Click ‘Get Form’ button to retrieve the eligibility screening record and open it in your preferred document editing tool.
2. Record the child's information, including their name, date of birth, and age in the designated fields. Ensure accuracy in all entries.
3. Fill in the parent's, guardian's, or individual's name who is responsible for the child, and include a contact phone number.
4. Identify the child's eligibility category by checking only one box that applies. Choose from options including Medicaid enrollment, CHIP benefits, American Indian or Alaskan Native status, being uninsured, or underinsured.
5. If applicable, provide the Medicaid or CHIP number and the corresponding date of eligibility.
6. If the child has private insurance that covers vaccines, note the insurer's name and contact number, along with the policy/subscriber number and group number if required.
7. Sign the form to attest that all provided information is accurate. Include the date of signing.
8. Once completed, save your changes, and you may choose to download, print, or share the form as necessary.

Complete your documents online today to ensure your child's eligibility for the TVFC immunization program.