Get Tx Pediatrics Plus Patient Information Packet 2019-2025

Completing the TX Pediatrics Plus Patient Information Packet online can be straightforward with the right guidance. This packet is essential for ensuring that your child receives the necessary therapy services tailored to their needs.

Follow the steps to complete the patient information packet efficiently.

1. Click ‘Get Form’ button to access the TX Pediatrics Plus Patient Information Packet and open it in your preferred digital editor.
2. Start by entering today’s date in the designated field at the top of the form.
3. Enter the social security number (SSN) of the patient in the provided space, followed by the patient's full name.
4. Indicate the patient's date of birth and race, making sure the information is accurate.
5. Provide information related to how the patient was referred to the clinic.
6. Fill out the details for the first parent or legal guardian, including their name, relationship to the patient, SSN, address, contact numbers, place of employment, and work phone.
7. Complete the information for the second parent or legal guardian, if applicable, following the same format as step-6.
8. Answer the question regarding foster care status and fill in the emergency contact information, ensuring to include a name, relationship, primary and alternate phone numbers.
9. Provide the primary care physician's information including their name, phone number, and address.
10. Enter the primary and, if applicable, secondary funding information, including the insurance company details, member ID, and policy holder’s name.
11. Document the child's birth history and general medical history, being as thorough as possible.
12. List any known allergies, medications the child is currently taking, and any prior therapies.
13. Outline general developmental milestones reached by the child and provide family medical history.
14. Finally, review all entered information for accuracy, and once satisfied, save the changes, download the completed form, or print/share it as needed.

Complete your TX Pediatrics Plus Patient Information Packet online today to ensure your child's therapy process starts smoothly.