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Form H1054-IME Receipt of Dental Service - Texas
What Is Form H1054-IME?
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 H1054-IME?
A: Form H1054-IME is a Receipt of Dental Service form used in Texas.
Q: When is Form H1054-IME used?
A: Form H1054-IME is used to document dental services received.
Q: Who uses Form H1054-IME?
A: Form H1054-IME is used by individuals in Texas who have received dental services.
Q: What information is required on Form H1054-IME?
A: Form H1054-IME requires information such as the name of the dentist, date of service, description of services provided, and amount charged.
Form Details:
- Released on June 1, 2019;
- 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 H1054-IME by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.
