Child Health Clinical Record Forms
Texas Health Steps Provider Outreach Referral Form - Beginning April 1, 2013, the Texas Health Steps Provider Outreach Referral Form should be used by all Texas Health Steps providers who submit a request for outreach on behalf of one of their Texas Health Steps patients as it replaces the Texas Health Steps Missed Appointment Referral Form. The new referral form and an instruction guide for completing it are available for download by selecting the link above.
Texas Health Steps Medical Checkup Forms
Providers may order lab supplies by calling 512-776-7661 or online at http://www.dshs.state.tx.us/lab/mrs_forms.shtm#supplies.
THSteps Specimen Collection and Handling Guidance
Newborn Screening (NBS) Specimen Collection Form Presentation [PPT 412KB] - A written request for NBS specimen collection forms and NBS supplies is required. To obtain an order form for written requests call 512-776-7661. To obtain NBS test results, call the NBS Automated Voice Response System (personal identification number is required) at 512-776-7300 or 1-888-963-7111, ext. 7300. For more detailed information, visit the NBS website. Note that the Newborn Screen is the only test performed by the DSHS Laboratory for Children's Health Insurance Program (CHIP) recipients.
Registered nurses (RNs) without CNS, NP, or CNM certification may provide medical checkups only under direct physician supervision, meaning the physician is either on site during the checkup or immediately available to furnish assistance and direction to the RN during the checkup. When a physician has delegated a complete THSteps medical checkup to an RN, the physician must establish the RN’s competency to perform the service prior to the delegation as required by the physician’s scope of practice. The delegating physician provider is responsible for the direct supervision of the RN performing the delegated service and remains responsible for any service provided to the client. Prior to performing a checkup the RN must complete the required training modules which are included in this optional competency verification form. The RN or the RN’s employer must maintain documentation of course completion in the employee’s record.
Verification of Registered Nurse Competency to Perform Texas Health Steps Checkups form in DOC [1.03MB] or PDF [201KB] Updated December 2012
Developmental Screening Forms
Ages and Stages
Modified Checklist for Autism in Toddlers (M-CHAT™) and authorization for use of form.
Spanish M-CHAT™ Form [PDF 72KB]
Bright Futures - Prevention and health promotion for infants, children, adolescents, and their families.
CDC recommends that health care providers: