TX DSHS C-102 2010 free printable template
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Immunization Record (Registry de Inmunizaciones) Name (Hombre) Last (Adelaide) First (Hombre) Middle Initial (Initial) Date of Birth (Tech de Nacimiento) Sex (SEO) Address (Direction) City (Ciudad)
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How to fill out TX DSHS C-102
How to fill out TX DSHS C-102
01
Obtain the TX DSHS C-102 form from the Texas Department of State Health Services website or office.
02
Fill in the top section with your name, address, and contact information.
03
Complete the 'Type of Service' section by selecting the appropriate services provided.
04
Provide details in the 'Client Information' section, including the client's name, date of birth, and insurance information if applicable.
05
Fill out the 'Provider Information' section, detailing the provider's name and license number.
06
Complete sections related to the service dates, locations, and any relevant notes or comments.
07
Review the entire form for accuracy and ensure all mandatory fields are filled out.
08
Sign and date the form before submission.
Who needs TX DSHS C-102?
01
Healthcare providers that are required to report specific data to the Texas Department of State Health Services.
02
Agencies or organizations providing health-related services that need to comply with state reporting requirements.
03
Individuals or entities that need to document client services for legal or billing purposes.
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People Also Ask about
What is ImmTrac2 Texas Immunization Registry?
Introducing ImmTrac2: The Texas Immunization Registry The Texas Immunization Registry is a no-cost service that consolidates and stores vaccine records from a variety of sources, including: Health Care Providers. Pharmacies. Public Health Clinics.
What is Texas Immunization Registry ImmTrac2?
Introducing ImmTrac2: The Texas Immunization Registry The Texas Immunization Registry is a no-cost service that consolidates and stores vaccine records from a variety of sources, including: Health Care Providers. Pharmacies. Public Health Clinics.
How do I get my immunization records in Texas?
If you need proof of immunization, the best place to start is by contacting the clinic, doctor, or healthcare provider that administered the vaccination. If your provider has the record on file, this will be the fastest way of obtaining your records.
How to add vaccines to ImmTrac2?
You can submit immunization data to ImmTrac2 various ways: Submit files ImmTrac2 via encrypted File Transfer Protocol (FTP). Medicaid and CHIP submit client data to HHSC electronically via the ImmTrac2 HHSC Interface. Health plans can submit data for multiple clients via secure download or encrypted FTP.
Does Texas have a state immunization registry?
Texas Department of State Health Services (DSHS) offers the Texas Immunization Registry at no cost to all Texans. The registry is secure and confidential, and safely consolidates and stores immunization records from multiple sources in one centralized system.
Is Texas Immunization Registry required?
Since 2005, Texas law has required that all healthcare providers report to the Texas Immunization Registry all vaccines administered to children younger than 18 years of age.
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What is TX DSHS C-102?
TX DSHS C-102 is a form used by the Texas Department of State Health Services for reporting specific public health information.
Who is required to file TX DSHS C-102?
Individuals or entities that provide certain healthcare services or encounter reportable diseases are required to file TX DSHS C-102.
How to fill out TX DSHS C-102?
To fill out TX DSHS C-102, complete the form by providing the required information accurately, ensuring all sections are filled out according to the guidelines provided by the Texas DSHS.
What is the purpose of TX DSHS C-102?
The purpose of TX DSHS C-102 is to collect important data related to public health to help monitor and control diseases within Texas.
What information must be reported on TX DSHS C-102?
Information that must be reported on TX DSHS C-102 includes patient demographics, specific health conditions or diseases, and service provider details.
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