TX DEPT OF FAMILY SERVICES AND PROTECTIVE SERVICES FORM 2403 Revised September 2013 MEDICAL/DENTAL/VISION/HEARING EXAMINATION FORM For STAR Health related questions, please contact the STAR Health.
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How to fill out the TX Form 2403 online
Completing the TX Form 2403 is a vital step in documenting medical, dental, vision, and hearing examinations for children under the care of the department. This guide provides a detailed, step-by-step approach to filling out this important form online.
Follow the steps to effectively complete the TX Form 2403 online.
- Select the ‘Get Form’ button to access the TX Form 2403 for completion.
- Begin with the General Information section. Here, the caregiver or caseworker must enter details about the child, including the child’s name, date of birth, and PID#.
- Next, input the examination date. This will be essential for tracking the child’s medical history.
- Provide caregiver information, including their name, contact phone number, agency, and address, as well as the city, state, and ZIP code.
- Enter the CPS caseworker's details, which include their name, phone number, and fax number to ensure proper communication.
- Indicate the reason for the child’s visit by selecting from the multiple choice options provided, detailing the specific needs for examination.
- Complete the medications and allergies section. Specify any medications the child is currently taking or list any known allergies.
- In the Health Care Examination section, replicate the child’s name and date of birth, and input the examination date as done previously.
- Select the type of visit (medical, dental, or specialty) and fill out all corresponding fields, including results of the examination and any vitals recorded.
- Follow up with any additional notes required for procedures or tests done during the visit.
- Before finalizing, ensure all provided information is accurate and complete. Save your changes, and then download, print, or share the form as necessary.
Complete the TX Form 2403 online now to ensure proper health documentation for the child.
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