TX HHS Form 1090. Oral Evaluation and Fluoride Varnish Certification Application

The Texas Health and Human Services (HHS) Form 1090, Oral Evaluation and Fluoride Varnish Certification Application, is a crucial document for healthcare providers in the state of Texas. This form helps solve the problem of ensuring that primary care providers are certified to administer fluoride varnish treatments to patients, particularly children, as part of oral health evaluations.

The Form 1090 requires providers to provide specific information, including their individual National Provider Identifier (NPI) number, group NPI number, and Texas Health Steps (THSteps) personal TP! number. Providers must also indicate whether they are currently enrolled as a THSteps Primary Care Provider and have submitted an application as of the date of submission. Additionally, providers must provide their physical address, ZIP code, area code and phone number, office contact information, email address, and date training completed.

To complete the Form 1090, providers should submit the form along with their CE certificate by email at [email protected] or fax to 512-483-3979. Key points to note include:

• Required information includes individual and group NPI numbers, THSteps personal TP! number, physical address, and contact information.
• Providers must indicate their current enrollment status with THSteps and submission date of application.
• The form must be submitted along with the CE certificate to complete the certification process.