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THSteps Forms
C.1 Claim Forms C-2
C.2 Child Health Clinical Records C-2
C.3 Guidelines for Tuberculosis Skin Testing C-2
C.4 Laboratory Forms C-2
C.5 Child Health History (2 Pages) C-3
C.6 Child Health Record (Birth-1 Month) (2 Pages) C-5
C.7 Child Health Record (2-6 Months) (2 Pages) C-7
C.8 Child Health Record (7-12 Months) (2 Pages) C-9
C.9 Child Health Record (13 Months-2 Years) (2 Pages) C-11
C.10 Child Health Record (3-5 Years) (2 Pages) C-13
C.11 Child Health Record (6-10 Years) (2 Pages) C-15
C.12 Hearing Checklist for Parents C-17
C.13 Hearing Checklist for Parents (Spanish) C-18
C.14 Mental Health Interview Tool/Referral Form (Ages 0-2 Years) C-19
C.15 Mental Health Interview Tool/Referral Form (Ages 3-9 Years) C-20
C.16 Mental Health Interview Tool/Referral Form (Ages 10-12 Years) C-21
C.17 Mental Health Interview Tool/Referral Form (Ages 13-20 Years) C-22
C.18 Mental Health Parent Questionnaire (Ages Birth-2 Years) (2 Pages) C-23
C.19 Mental Health Questionnaire (Ages Birth-2 Years) (2 Pages) (Spanish) C-25
C.20 Mental Health Parent Questionnaire (Ages 3-9 Years) (2 Pages) C-27
C.21 Mental Health Parent Questionnaire (Ages 3-9 Years) (2 Pages) (Spanish) C-29
C.22 Mental Health Parent Questionnaire (Ages 10-12 Years) (2 Pages) C-31
C.23 Mental Health Parent Questionnaire (Ages 10-12 Years) (2 Pages) (Spanish) C-33
C.24 Mental Health Parent Questionnaire (Ages 13-20 Years) (2 Pages) C-35
C.25 Mental Health Parent Questionnaire (Ages 13-20 Years) (2 Pages) (Spanish) C-37
C.26 Form Pb-110, Risk Assessment for Lead Exposure C-39
C.27 Tuberculosis (TB) Screening and Education Tool C-41
C.28 TB Questionnaire C-42
C.29 Cuestionario Para la Detección de Tuberculosis C-43
C.30 How to Determine TB Risk C-44
C.31 PPD Agreement for Texas Health Steps Providers C-45
C.32 TVFC Patient Eligibility Screening Record C-46
C.33 TVFC Patient Eligibility Screening Record (Spanish) C-47
C.34 TVFC Provider Enrollment (3 Pages) C-48
C.35 TVFC Questions and Answers (3 Pages) C-51
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