Get Tx Publication F18-11669 2020-2025

This guide provides users with clear and supportive instructions on how to properly fill out the TX Publication F18-11669 form online. Whether you are a healthcare provider or someone involved in the process, understanding each component of this form is essential for compliance.

Follow the steps to accurately complete the form online.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by entering the applicant's name in the designated field, which should include the first name, middle initial, and last name.
3. Fill in the applicant's date of birth following the format requested in the form.
4. Enter the applicant's social security number accurately to ensure proper identification.
5. Provide the street address where the applicant resides, followed by the city and state.
6. Input the telephone number of the applicant in the specified format.
7. The physician should document the date they saw the applicant, specifying the date in the provided space.
8. As a physician, complete the required sections on the medical questionnaire, thorough review of work history, and any evaluations performed in relation to asbestos exposure.
9. Indicate whether a chest x-ray was performed and, if applicable, provide a detailed comment on the evaluation's outcome concerning the applicant's health.
10. Ensure that all mandatory signatures and dates, including the physician’s signature, printed name, and date of the examination, are completed.
11. Finally, review the completed form for accuracy before saving changes, downloading, or printing the document.

Complete the TX Publication F18-11669 form online today to ensure compliance and proper documentation.