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TX DSHS F76-10789 2013-2026 free printable template

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Budget: ZZ117 Fund: 158 STATE BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY Mail Code: MC1982 PO Box 149347 Austin, Texas 78714-9347 Phone: (512) 834-6627 Fax: (512) 834-6677 E-mail:
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How to fill out TX DSHS F76-10789

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How to fill out TX DSHS F76-10789

01
Obtain the TX DSHS F76-10789 form from the Texas Department of State Health Services website or at a local DSHS office.
02
Fill in the required identification information at the top of the form, such as your name, address, and contact details.
03
Provide accurate details regarding the service or information being requested in the designated sections.
04
Complete any required checkboxes or options that apply to your request.
05
Review all the information to ensure it is accurate and complete.
06
Sign and date the form at the bottom.
07
Submit the completed form either by mail or in person to the appropriate DSHS office.

Who needs TX DSHS F76-10789?

01
Individuals seeking public health information or resources from the Texas Department of State Health Services may need this form.
02
Health care providers needing to request patient information or services related to public health.
03
Organizations or entities involved in health-related services or research requiring data from DSHS.
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License renewal forms can be completed and submitted online using the online licensing system. If you are unable to renew online, please email us to request a paper renewal form.
If you have already obtained a bachelor's degree in an area other than Communication Sciences and Disorders, then you may pursue courses as a Post-Bachelor's student that meet the requirements to become a licensed SLPA in Texas.
The SLPA certificate program prepares students for Texas licensure and national certification as a speech-language pathology assistant. Students in the SLPA Certificate program may elect to add two additional courses to their plan of study that will also prepare them for graduate school application.
Speech-Language Pathologists: Texas License issued for a two-year term: 20 clock hours (two CEUs), with 2 clock hours (0.2 CEUs) in ethics. Dual license in speech-language pathology and audiology: (Two-year term): 30 clock hours (three CEUs), with 2 clock hours (0.2 CEUs) in ethics.
Educational Requirements All applicants must have at least 24 semester credit hours in speech-language pathology and/or audiology (up to 6 credit hours of audiology may count toward the 24 credit hours), including at least three hours in language disorders and at least three hours in speech disorders.
An SLP may not supervise more than a total of four interns and/or assistants and must have two years of professional experience in providing direct client services.

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TX DSHS F76-10789 is a form used by the Texas Department of State Health Services for reporting specific health-related data.
Healthcare providers, facilities, or organizations that meet certain criteria or are mandated by law to report specific health data are required to file TX DSHS F76-10789.
To fill out TX DSHS F76-10789, one must gather the required information, complete the form accurately, and ensure it is submitted by the specified deadline to the appropriate authority.
The purpose of TX DSHS F76-10789 is to collect and report important health data that can be used for monitoring public health trends, compliance, and improving healthcare services.
The information that must be reported on TX DSHS F76-10789 typically includes patient demographics, specific health conditions, treatment provided, and other relevant health data as required by the form.
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Relevant keywords

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