Get Intake Packet - Texana Center

This guide provides clear, step-by-step instructions for completing the Intake Packet for Texana Center online. By following these steps, you will be able to accurately provide the necessary information for services related to intellectual and developmental disabilities.

Follow the steps to successfully complete the Intake Packet.

1. Click ‘Get Form’ button to obtain the Intake Packet and open it for completion.
2. Begin by entering the case number, applicant’s name, social security number, date of birth, and age in the designated fields. Ensure that all personal information is accurately filled out.
3. Next, provide the applicant’s address, including the street, city, state, and zip code, in the appropriate fields.
4. Indicate the applicant's sex by selecting either the Female or Male option clearly marked on the form.
5. Enter the Medicaid number if applicable, and select 'Yes' or 'No' regarding participation in Star Plus, along with the appropriate Medicaid group options.
6. Fill in the telephone number and alternate telephone number for the applicant or their representative to ensure proper communication.
7. Complete the referral information section by providing the name of the person completing the assessment, their relationship to the applicant, and the interviewer's name if applicable.
8. Identify how you were referred to Texana IDD Services and specify the type of service or assistance being sought by checking the relevant boxes in the service options provided.
9. Once all sections are filled out, review the information entered to ensure accuracy and completeness.
10. Save your changes, and then proceed to download, print, or share the completed form as needed, ensuring it is submitted to the specified address.

Start filling out the Intake Packet online to access vital services for intellectual and developmental disabilities.