TX HHS Form H4701. HHSC Out Card

The HHSC Out Card (Form H4701) helps healthcare providers efficiently manage patient information and billing processes. This form is typically used in situations where patients receive medical services and require documentation of charges for reimbursement or insurance purposes.

This out-of-pocket charge card provides a standardized format for recording patient charges, including date charged to, name, and amount. The form also serves as a reminder for healthcare providers to maintain accurate records and follow up with patients regarding outstanding balances. Key features include the required information of date charged to and amount, which ensures transparency in billing processes.

• This form is used by healthcare providers to document patient charges and facilitate reimbursement or insurance claims.