Get Tx Hhsc Form 7484 2024-2026

The TX HHSC Form 7484 is essential for reporting the birth of a child under the Texas Medicaid Program. This guide provides clear, step-by-step instructions on how to complete the form online efficiently and accurately.

Follow the steps to fill out the TX HHSC Form 7484 online.

1. Click ‘Get Form’ button to access the form and open it in your document editor.
2. Begin by entering the mother's name in the designated fields, including last name, first name, and middle initial if applicable.
3. Fill in the admission date of the mother, ensuring it reflects the appropriate date of hospital admission.
4. Provide the mother's Medicaid recipient number and date of birth in the specified fields.
5. Complete the mother’s medical record number accurately to maintain proper documentation.
6. For each child, enter their date of birth and medical record number in the respective sections. If the child’s first name is unknown, use the last name.
7. Indicate the child's name and sex using the available selections. Ensure that all children's information is filled out correctly.
8. If applicable, record whether the mother has relinquished her rights to the newborn and provide the date of relinquishment.
9. Insert the attending physician's details, including the physician's name, medical license number, and Texas provider identifier.
10. Fill in the hospital's name and address accurately in the provided fields.
11. Complete the ‘Completed By’ section with the necessary contact information, including the hospital area code and phone number.
12. Finally, note the date the form is mailed. Review all entries for accuracy before submission.
13. Save the completed form, and consider downloading or printing a copy for your records. Share or submit the form as instructed.

Complete TX HHSC Form 7484 online to ensure timely processing of Medicaid claims for newborns.