Downloadable Forms | Texas Children's Health Plan
Combating Opioid Abuse CME/CNE

OB, family practice and pedi providers can learn how to respond to the effects of opioid use on newborns and during pregnancy.

Downloadable Forms

Below you will find useful forms for you and your practice. If you wish to open the following forms, you must have Adobe Acrobat Reader installed on your computer. To download a form, right click on one of the links below and select "Save Target As."

To download a free copy of Adobe Acrobat Reader, click here.

Reimbursement Information for CHIP Co-Payment Waiver

Authorizations

  • Standard Prior Authorization Form
  • Medical Services Fax Line - 832-825-8760 or Toll-Free 1-844-473-6860
  • Behavioral Health Services Fax Line - 832-825-8767 or Toll-Free 1-844-291-7505
  • LTSS and Private duty Nursing Fax Line - 346-232-4757 or Toll-Free 1-844-248-1567

Case Management

Physician Requests

Other Forms