DOCUMENTS AND FORMS

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You can find links to the necessary documents and forms below. Just click on the button of the form you need and you will be redirected to a digital copy. You may print out these forms or fill out an electronic copy to be e-mailed. NOTE: The forms are writeable so you can fill them out online then print them.

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HIPPAA

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Change of Provider

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Prescription Form

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ED Pump RX

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Texas Medicaid Application English

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Texas Medicaid Application – Spanish