| Application for Texas Identification Number (PDF) | HHS Form 4109 |
| Biosynthetic Growth Hormone Agents Prior Authorization Request - CSHCN Services Program | HHS Form 1327 |
| CHIP Drug Rebate Agreement | HHS Form 1337 |
Comprehensive Care Program (CCP) Prior Authorization Request Form (PDF) | TMHP Form F00012 |
| CSHCN Services Program Rebate Agreement | HHS Form 1343 |
| Cystic Fibrosis Treatment Agents (Kalydeco/Orkambi/Symdeko) Prior Authorization Request (Medicaid) | HHS& Form 1338 |
| Cystic Fibrosis Treatment Products Authorization Request - CSHCN Services Program | HHS Form 1143 |
| Direct Deposit Authorization (PDF) | CPA 74-176 |
| Draft Policy Comment Submission | HHS Form 1342 |
| Drug Shortage Notification and Expedited Formulary or Preferred Drug List Request | HHS Form 1315 |
| Drug Utilization Review (DUR) Board Annual Disclosure | HHS Form 1349 |
| Drug Utilization Review (DUR) Board Public Testimony Registration | HHS Form 1320 |
| Drug Utilization Review (DUR) Board Written Testimony Registration | HHS Form 1334 |
| Emflaza Prior Authorization Request | HHS Form 1347 |
Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form (PDF) | TMHP Form F00030 |
| HHS Data Use Agreement (PDF) | |
| HHS Uniform Terms and Conditions (PDF) | |
| Increlex Authorization Request - Medicaid | HHS Form 1357 |
| KHC Program Drug Rebate Agreement | HHS Form 1329 |
Long-acting Reversible Contraception (LARC) Product Forms | |
| MCO Search Update Request | HHS Form 1344 |
| Medicaid Fee-For-Service Prior Authorization Reconsideration Request | HHS Form 1322 |
| OxyContin Authorization Request - Medicaid | HHS Form 1353 |
| Palivizumab (Synagis) Prior Authorization Request - Medicaid | HHS Form 1321 |
| Palivizumab (Synagis) Prior Authorization Request - CSHCN Services Program | HHS Form 1325 |
| PCSK9 Inhibitor Agents Authorization Request - Medicaid | HHS Form 1355 |
| Pharmacy Claims Billing Request | HHS Form 1319 |
| Pharmacy Ownership Transfer Affidavit | HHS Form 1332 |
| Phosphate Binder Agents Authorization Request - Medicaid | HHS Form 1348 |
| Prior Quarter Adjustment Statement | CMS 304a |
| Reconciliation of State Invoice | CMS 304 |
| Texas Standard Prior Authorization Request Form for Prescription Drug Benefits (PDF) - Medicaid | TDI Form NOFR002 |
| Texas Standard Prior Authorization Request Form for Prescription Drug Benefits (PDF) - CSHCN Services Program | TDI Form NOFR002 |
| Value-Based Agreement Concept | HHS Form 1402 |
| Xyrem Authorization Request - Medicaid | HHS Form 1356 |
