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THSteps Forms
C.1 Claim Forms C-3
C.2 Child Health Clinical Records C-3
C.3 Child Health History (2 Pages) C-4
C.4 Child Health Record (Birth-1 Month) (2 Pages) C-6
C.5 Child Health Record (2-6 Months) (2 Pages) C-8
C.6 Child Health Record (7-12 Months) (2 Pages) C-10
C.7 Child Health Record (13 Months-2 Years) (2 Pages) C-12
C.8 Child Health Record (3-5 Years) (2 Pages) C-14
C.9 Child Health Record (6-10 Years) (2 Pages) C-16
C.10 Hearing Checklist for Parents C-18
C.11 Hearing Checklist for Parents (Spanish) C-19
C.12 Mental Health Interview Tool/Referral Form (Ages 0-2 Years) C-20
C.13 Mental Health Interview Tool/Referral Form (Ages 0-2 Years) (Spanish) C-21
C.14 Mental Health Interview Tool/Referral Form (Ages 3-9 Years) C-22
C.15 Mental Health Interview Tool/Referral Form (Ages 3-9 Years) (Spanish) C-23
C.16 Mental Health Interview Tool/Referral Form (Ages 10-12 Years) C-24
C.17 Mental Health Interview Tool/Referral Form (Ages 10-12 Years) (Spanish) C-25
C.18 Mental Health Interview Tool/Referral Form (Ages 13-20 Years) C-26
C.19 Mental Health Interview Tool/Referral Form (Ages 13-20 Years) (Spanish) C-27
C.20 Mental Health Parent Questionnaire (Ages Birth-2 Years) (2 Pages) C-28
C.21 Mental Health Questionnaire (Ages Birth-2 Years) (2 Pages) (Spanish) C-30
C.22 Mental Health Parent Questionnaire (Ages 3-9 Years) (2 Pages) C-32
C.23 Mental Health Parent Questionnaire (Ages 3-9 Years) (2 Pages) (Spanish) C-34
C.24 Mental Health Parent Questionnaire (Ages 10-12 Years) (2 Pages) C-36
C.25 Mental Health Parent Questionnaire (Ages 10-12 Years) (2 Pages) (Spanish) C-38
C.26 Mental Health Parent Questionnaire (Ages 13-20 Years) (2 Pages) C-40
C.27 Mental Health Parent Questionnaire (Ages 13-20 Years) (2 Pages) (Spanish) C-42
C.28 Form Pb-110, Risk Assessment for Lead Exposure C-44
C.29 San Antonio State Chest Hospital Cervical Cancer Cytology Laboratory C-46
C.30 Specimen Submission Form G-1B, Biochemistry, Instructions (2 Pages) C-48
C.31 Specimen Submission Form G-1B, Biochemistry C-50
C.32 Specimen Submission Form G-1B, Biochemistry, Spanish Instructions (3 Pages) C-51
C.33 Specimen Submission Form G-1B, Biochemistry (2 Pages) (Spanish) C-54
C.34 Specimen Submission Form G-2A, Serology and Virology, Instructions (2 Pages) C-56
C.35 Specimen Submission Form G-2A, Serology and Virology C-58
C.36 Specimen Submission Form G-2A, Serology and Virology
(3 Pages) (Spanish Instructions) C-59
C.37 Specimen Submission Form G-2A, Serology and Virology (2 Pages) (Spanish) C-62
C.38 Specimen Submission Form G-2B, Bacteriology and Parasitology,
Instructions (2 Pages) C-64
C.39 Specimen Submission Form G-2B, Bacteriology and Parasitology C-66
C.40 Specimen Submission Form G-2B, Bacteriology and Parasitology (3 Pages) (Spanish) C-67
C.41 Specimen Submission Form G-2B, Bacteriology and Parasitology (2 Pages) (Spanish) C-70
C.42 Guidelines: Tuberculosis Skin Testing (2 Pages) C-72
C.43 Tuberculosis (TB) Screening and Education Tool C-74
C.44 TB Questionnaire C-75
C.45 Cuestionario Para la Detección de Tuberculosis C-76
C.46 How to Determine TB Risk C-77
C.47 PPD Agreement for Texas Health Steps Providers C-78
C.48 TVFC Patient Eligibility Screening Record C-79
C.49 TVFC Patient Eligibility Screening Record (Spanish) C-80
C.50 TVFC Provider Enrollment (3 Pages) C-81
C.51 TVFC Questions and Answers (3 Pages) C-84
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