Get Physicians Examination Report - Tmhp

Filling out the Physicians Examination Report - TMHP online is a straightforward process that ensures accuracy and efficiency in submitting medical evaluations for hearing aids. This guide provides clear, step-by-step instructions to assist you in completing the form correctly.

Follow the steps to successfully complete the Physicians Examination Report - TMHP online.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering the client’s name, formatted as Last, First, in the designated field.
3. Input the client number in the provided space, ensuring it is accurate.
4. Fill in the date of birth for the client in the specified format.
5. Enter the complete address, including street, city, state, and zip code of the client.
6. Provide the date of examination in the appropriate field, marking it clearly.
7. For the ear examination section, indicate if the ear is within normal limits by selecting 'Yes' or 'No'.
8. State whether cerumen was removed by selecting 'Yes' or 'No'.
9. Describe any ear abnormalities in the provided space, using clear language to detail the findings.
10. Answer whether more otolaryngological examination/treatment is required by selecting 'Yes' or 'No'. If necessary, make a note to refer the patient for further consultation.
11. Indicate if there are any medical contradictions to hearing aid usage in either ear by selecting 'Yes' or 'No'. If applicable, specify which ear is medically prohibited.
12. Determine if the individual is a candidate for a hearing aid evaluation by selecting 'Yes' or 'No'.
13. The physician must sign the report, along with typing or printing their name, including their medical specialty.
14. Provide the physician's telephone number in the specified field.
15. Once the form is completed, ensure to furnish the patient with the signed original and one copy of this form.
16. To be reimbursed for the examination, submit the completed form along with a claim to the Texas Medicaid & Healthcare Partnership at the provided address.

Start completing the Physicians Examination Report - TMHP online today to streamline the process!