TX HHS Form 3032. Hemophilia Assistance Program (HAP) Physical Assessment

The TX HHS Form 3032, Hemophilia Assistance Program (HAP) Physical Assessment, is a crucial document used to evaluate the physical health of individuals applying for the Hemophilia Assistance Program. This form should be completed by the applicant's Texas-licensed physician only and is typically used in conjunction with Form 3033, Hemophilia Assistance Program Application.

This assessment requires the physician to provide essential medical information, including the applicant's name, treating physician details, and International Classification of Diseases (ICD) code. The form also includes an acknowledgment section where the physician confirms that the facts in the application are true and correct. The signed form should be returned to the applicant or faxed to 512-206-3982 or mailed to Hemophilia Assistance Program at P.O. Box 149030, Mail Code 1938 Austin, TX 78714-9947.

The TX HHS Form 3032 is an essential tool for healthcare professionals and applicants seeking assistance through the Hemophilia Assistance Program. By providing a comprehensive physical assessment, this form helps ensure that individuals receive the necessary support and care to manage their hemophilia effectively. If you have any questions or concerns, please call 800-222-3986.