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Form 3058 Children With Special Health Care Needs (Cshcn) Services Program Regional Verification Worksheet - Texas
What Is Form 3058?
This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 3058 Children With Special Health Care Needs (Cshcn) Services Program Regional Verification Worksheet?
A: Form 3058 is a verification worksheet for the Children With Special Health Care Needs (Cshcn) Services Program in Texas.
Q: What is the purpose of the Cshcn Services Program?
A: The Cshcn Services Program provides access to specialized health care services for children with special health care needs.
Q: Who is eligible for the Cshcn Services Program?
A: Children in Texas under the age of 21 with chronic illnesses, disabilities, or other special health care needs may be eligible for the program.
Q: What information is needed on the Form 3058?
A: The form requires information about the child's medical condition, treatment needs, and the income and resources of the household.
Form Details:
- Released on January 1, 2020;
- The latest edition provided by the Texas Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form 3058 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.
Download Form 3058 Children With Special Health Care Needs (Cshcn) Services Program Regional Verification Worksheet - Texas
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