TX HHS Form H1093. Texas Health Steps Extra Effort Referral

The Texas Health Steps Extra Effort Referral Form (Form H1093) is a tool designed to facilitate additional assistance for families in need of services. This form helps solve the problem of accessing healthcare services by providing a mechanism for identifying and addressing specific needs. Typically, this form is used when a family requires extra support to access medical, dental, or case management services.

The form requests key information including the child's name, date of birth, Medicaid ID number, mailing address, and home address (if different). Additionally, it asks for the reason why additional assistance is needed, which can include scheduling a checkup or appointment, transportation, or more information on available services. The form also allows for specifying special needs, language requirements, and disability accommodations.

To complete this form, users should select all applicable options from the provided list. Once completed, the form can be faxed to 512-533-3867. This form is an essential tool for families seeking additional support in accessing healthcare services. Key points to keep in mind include:

• Identifying specific needs and reasons for extra assistance
• Scheduling appointments or checkups as needed
• Requesting information on available medical, dental, and case management services
• Faxing the completed form to 512-533-3867