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Form H1550 Out of State Nbccedp Verification - Texas
What Is Form H1550?
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 H1550?
A: Form H1550 is a verification form for the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in Texas.
Q: What is the NBCCEDP?
A: The NBCCEDP is a national program that provides low-cost or free breast and cervical cancer screenings to eligible women in the United States.
Q: Who needs to complete Form H1550?
A: Healthcare providers in Texas who are seeking out-of-state verification for NBCCEDP patients need to complete Form H1550.
Q: What information is required on Form H1550?
A: Form H1550 requires information about the healthcare provider, the patient, the requested out-of-state service, and the NBCCEDP diagnosis and treatment history for the patient.
Form Details:
- Released on July 1, 2015;
- 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 printable version of Form H1550 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.
