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Appendix A: THSteps Forms
A.1 Claim Forms CH-296
A.2 Child Health Clinical Records CH-296
A.3 Guidelines for Tuberculosis Skin Testing CH-297
A.4 Laboratory Forms CH-297
CH.37 Child Health History (2 Pages) CH-298
CH.38 Child Health Record (Birth-1 Month) (2 Pages) CH-300
CH.39 Child Health Record (2-6 Months) (2 Pages) CH-302
CH.40 Child Health Record (7-12 Months) (2 Pages) CH-304
CH.41 Child Health Record (13 Months-2 Years) (2 Pages) CH-306
CH.42 Child Health Record (3-5 Years) (2 Pages) CH-308
CH.43 Child Health Record (6-10 Years) (2 Pages) CH-310
CH.44 Hearing Checklist for Parents CH-312
CH.45 Hearing Checklist for Parents (Spanish) CH-313
CH.46 Mental Health Interview Tool/Referral Form (Ages 0-2 Years) CH-314
CH.47 Mental Health Interview Tool/Referral Form (Ages 3-9 Years) CH-315
CH.48 Mental Health Interview Tool/Referral Form (Ages 10-12 Years) CH-316
CH.49 Mental Health Interview Tool/Referral Form (Ages 13-20 Years) CH-317
CH.50 Mental Health Parent Questionnaire (Ages Birth-2 Years) (2 Pages) CH-318
CH.51 Mental Health Questionnaire (Ages Birth-2 Years) (2 Pages) (Spanish) CH-320
CH.52 Mental Health Parent Questionnaire (Ages 3-9 Years) (2 Pages) CH-322
CH.53 Mental Health Parent Questionnaire (Ages 3-9 Years) (2 Pages) (Spanish) CH-324
CH.54 Mental Health Parent Questionnaire (Ages 10-12 Years) (2 Pages) CH-326
CH.55 Mental Health Parent Questionnaire (Ages 10-12 Years) (2 Pages) (Spanish) CH-328
CH.56 Mental Health Parent Questionnaire (Ages 13-20 Years) (2 Pages) CH-330
CH.57 Mental Health Parent Questionnaire (Ages 13-20 Years) (2 Pages) (Spanish) CH-332
CH.58 Risk Assessment for Lead Exposure: Parent Questionnaire, Form Pb-110 (2 Pages) CH-334
A.5 Tuberculosis Screening and Education Tool CH-336
CH.59 TB Questionnaire CH-337
CH.60 Cuestionario Para la Detección de Tuberculosis CH-338
CH.61 How to Determine TB Risk CH-339
CH.62 PPD Agreement for Texas Health Steps Providers CH-340
CH.63 TVFC Patient Eligibility Screening Record CH-341
CH.64 TVFC Patient Eligibility Screening Record (Spanish) CH-342
CH.65 TVFC Provider Enrollment (3 Pages) CH-343
CH.66 TVFC Questions and Answers (3 Pages) CH-346
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