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

The TX HHS Form 3032, Hemophilia Assistance Program Physical Assessment, is a crucial document that helps facilitate the application process for individuals with hemophilia. This form is typically completed by the applicant's Texas licensed physician to provide medical information and verify the accuracy of the application.

This physical assessment form requires the treating physician to provide specific information, including the applicant's name, provider type, national provider identifier number, and address. The form also includes an International Classification of Diseases (ICD) code, which is used to describe the applicant's medical condition. By signing the form, the physician acknowledges that the facts in the application are true and correct.

To complete this form, applicants should provide their treating physician with Form 3033, Hemophilia Assistance Program Application. The completed physical assessment form can be returned to the applicant or faxed to 512-206-3982. For any questions or concerns, applicants can call 800-222-3986. Key points to note include:

• The form is used in conjunction with Form 3033, Hemophilia Assistance Program Application.
• The treating physician must be licensed in Texas and provide specific medical information.
• The completed form can be returned to the applicant or faxed to the designated number.