Get Tx Dfps Form F-500-1600 2017-2025

Filling out the TX DFPS Form F-500-1600 is essential for authorizing representatives of Superior HealthPlan to request a Central Registry check on your behalf. This guide provides step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to effectively complete the TX DFPS Form F-500-1600.

1. Click the ‘Get Form’ button to access the form and open it in your online editor.
2. Begin by filling in the individual's identifying information. Include the first name, middle name, and last name. If applicable, indicate any other names or spellings used, such as married or maiden names. Use a separate page if necessary.
3. Provide the current mailing address along with the city, state, zip code, and telephone number. Ensure the information is complete and accurate.
4. Enter the email address and demographic information, including date of birth, sex, ethnicity, and race. This information is vital for the Central Registry check.
5. List any other addresses or cities in Texas where the individual has resided, using additional pages if required.
6. Review the privacy statement carefully. Make sure you understand the rights and responsibilities that come with requesting the Central Registry check.
7. Complete the signature section to certify that the information provided is correct and that you grant permission to Superior Health Plan to request the Central Registry check. Provide the date signed and printed name.
8. After filling out all sections, ensure there are no blanks. If a section does not apply, write ‘not applicable’ or ‘N/A’. Check for any errors and make corrections as needed.
9. Once completed, save your changes. You can then download, print, or share the form as necessary before sending it to Credentialing@SuperiorHealthPlan.com.

Complete and submit your TX DFPS Form F-500-1600 online today to ensure a smooth application process.