Texas Department of State Health Services Publications by Language Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
Chinese Lifestyles & Health / Estilos de vida y Salud E10-76C
Remember When Your Mother Used To Say "Just Drink This, It's Good For You?"
Osteoporosis - 225
Electronic File
Osteoporosis - 225
Electronic File
Osteoporosis - 225
Electronic File
Osteoporosis - 225
Electronic File
Minority Health / Salud de minorias E10-76C
Remember When Your Mother Used To Say "Just Drink This, It's Good For You?"
Osteoporosis / Osteoporosis E10-76C
Remember When Your Mother Used To Say "Just Drink This, It's Good For You?"
Women - Health & Hygiene / Mujeres--salud e higiene E10-76C
Remember When Your Mother Used To Say "Just Drink This, It's Good For You?"
English Abortion / Aborto EBVS013
Vital Statistics Annual Report 1998
Center for Health Statistics - 107
Electronic File
DSHS-3TIA
Third Trimester Induced Abortion Certification Form
Vital Statistics - 346
Electronic File
DSHS-EIA
Emergency Induced Abortion Certification Form
Vital Statistics - 346
Electronic File
E1-450
A Woman's Right to Know
Perinatal/Maternal/Child 455
Electronic File
E1-451
A Woman's Right To Know Resource Directory
Perinatal/Maternal/Child 455
Electronic File
E75-11987
Abortion Facility Personnel Training on Recognizing and Reporting Child Abuse
Abortion Facility Licensing - 470
Electronic File
HHS-687
Consent for Sterilization (Federal form: Health & Human Services)
federal form - 646
Electronic File
Indu-Abor-Rpt
Induced Abortion Report Form
Vital Statistics - 346
Electronic File
TAC139.41(a)(8)
Affidavit of Age Form (Abortion Facilities)
Abortion Facility Licensing - 634
Electronic File
TAC139.52(a)(1)
Informed Consent Certification Form (Abortion Facilities)
Abortion Facility Licensing - 634
Electronic File
TAC139.6(a)(1)
Information on Toll-Free Telephone Number (Abortion Facilities)
Abortion Facility Licensing - 634
Electronic File
E35-10559
Texas Vital Statistics Annual Report
Center for Health Statistics - 107
Electronic File
Accident Prevention & Safety / Prevencion de accidentes y Seguridad E15-24
Safety Inspection Checklist
Risk Management/Safety Office - 259
Electronic File
4-61
Ready Teddy Talks About Emergency Medical Services & Injury Prevention (Limit 500)
Warehouse
Coloring Books
Stock #4-25-lang Revised 10/25/2010
Page 1 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E09-12948
Nitrates in Drinking Water, Is the Water Your Children Drink Safe?
Hlth Assessment/Toxicology 754
Electronic File
E4-20-16
Occupational Health & Safety/Back Safety/Infection Control Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E15-25
Hazard Report Form
Risk Management/Safety Office - 259
Electronic File
E1-26
What Parents Need to Know About Lead Poisoning
Childhood Lead Poisoning - 386
Electronic File
Adolescence / Adolescencia EMH-10
Teen's Bill of Rights (mental health)
Mental Hlth-Substance Abuse - 670
Electronic File
EB-104
Life Can Be Tough
CMAP-Patient/Family Ed 654
Electronic File
EF05-11573
Adolescent Health Exam Packet & Preventative Services Checklist (11-21 years)
Adolescent Health - 338
Electronic File
TCADA-46
Texas Survey of Adult Gambling Behavior
Mental Hlth/Sub Abuse 489
Electronic File
E45-12285
Texas Cancer Control Toolkit
Comprehensive Cancer Control - 576
Electronic File
TCADA-44
Texas Survey of Adult and Adolescent Gambling Behavior
Mental Hlth/Sub Abuse 489
Electronic File
E16-11188
Texas Youth Tobacco Survey Reports
Substance Abuse Services - Electronic File Tobacco - 232
TCADA-45
Texas Survey of Adolescent Gambling Behavior
Mental Hlth/Sub Abuse 489
12-0214
Sex Can Wait, Talking Can't
Abstinence Education - 790 DVD
Electronic File
Adoption / Adopcion EFVS-145
Adult Adoptee Application for Non-Certified copy of Original Birth Certificate
Vital Statistics - 346
Electronic File
EFVS-160
Certificate of Adoption (for District Clerks)
Vital Statistics - 346
Electronic File
EFVS-166.531
Adoption Validation Petition (for District Clerks)
Vital Statistics - 346
Electronic File
EFVS-166.532
Adoption Validation Order (for District Clerks)
Vital Statistics - 346
Electronic File
FVS-160
Certificate of Adoption (for District Clerks)
Vital Statistics - 71
Forms
E35-11068
Texas Adoption Information and the Central Adoption Registry Brochure
Vital Statistics - 745
Electronic File
EFVS-143
Request for Identity of Court of Adoption
Vital Statistics - 346
Electronic File
adop-court
Request for Identity of Court of Adoption
Vital Statistics - 71
Electronic File
Aging / Envejecimiento E44-10831
1998-99 Biennial Report of the Osteoporosis Advisory Committee
Osteoporosis - 225
Electronic File
E44-10937
Osteoporosis Resource Guide
Osteoporosis - 225
Electronic File
E25-10990
Aging Texas Well 1999: A Health Perspective
Prog Coord, Policy & Innov - 101
Electronic File
E4-20-8
Alzheimer's Disease, Aging, Long Term Care, Infection Control, Fire Safety, Back Safety
Audiovisual Library - 196
Electronic File
E44-10946
Your Life is About to Change for the Better (general audiences)
Osteoporosis - 225
Electronic File
AIDS/HIV / SIDA/VIH F13-12219
Voluntary Guest Sign-In Form (HIV/STD)
HIV/STD - 104
Forms
E4-20-13
AIDS/Hepatitis/Sexually Transmitted Diseases/Tuberculosis Audiovisual Catalog
Audiovisual Library - 196
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 2 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E4-206
10 Questions About Pregnancy and HIV
HIV/STD - 332
Electronic File
E4-213
What About Your Partners? (Partner Notification)
HIV/STD - 332
Electronic File
E4-218
Texas HIV Medication Program
HIV/STD - 332
Electronic File
EJ-6
Disclosure and Consent for HIV
HIV/STD - 734
Electronic File
E13-10959
1998 Behavioral Risk Factor Surveillance System HIV/AIDS Section and Sexual Behavior Module
HIV/STD - 447
Electronic File
Emerg-ADAP
Emergency Relief ADAP Application (Hurricane Katrina)
HIV/STD - 560
Electronic File
E13-10667
Texas HIV/STD Annual Report
HIV/STD - 447
Electronic File
F13-12209
HIV/AIDS Testing History Case Report Addendum (formerly Form I - HIV Testing History)
HIV/STD - 104
Forms
CDC5042A
AIDS Case Report Form
HIV/STD - 44
Forms
F13-12218
Member Statement of Confidentiality (HIV/STD)
HIV/STD - 104
Forms
Med-Cert-HIV
Texas HIV Medication Program Medical Certification Form
HIV/STD - 410
Forms
TCADA-35
Crack Cocaine as a Major Risk of HIV Transmission in a Crack House Population
Mental Hlth/Sub Abuse 488
Electronic File
13-13342
InSpot Texas poster
HIV/STD - 44
Posters
4-226
I Did it for My Man (HIV poster for African American MSM) (Limit 100)
Warehouse
Posters
4-147
You Can't Get AIDS (Limit 50)
Warehouse
Posters
4-225
HIV is No Match for Strong Black Women (poster for African American Women) (Limit 100)
Warehouse
Posters
4-162
If You Have Two Sex Partners (Limit 50)
Warehouse
Posters
E13-11275
Texas HIV/STD Surveillance Report
HIV/STD - 447
Electronic File
4-222
I Did It for My Sister (HIV poster for African American MSM) (limit 100)
Warehouse
Posters
4-224
HIV Can't Stop a Strong Black Woman (poster for African American women) (Limit 100)
Warehouse
Posters
F13-12210
HIV Testing History Interview Form (formerly Form II - HIV Testing History)
HIV/STD - 104
Forms
E13-13176
Expedited Partner Therapy in Texas
HIV/STD - 783
Electronic File
E4-158
Should I Get an HIV Test?
HIV/STD - 332
Electronic File
E13-12986
An Overview of HIV/AIDS in Texas
HIV/STD - 783
Electronic File
E13-13497
Black Women and HIV in San Antonio
HIV/STD - 886
Electronic File
E13-13033
Syringe Exchange as HIV and Hepatits Prevention
HIV/STD - 783
Electronic File
E13-13496
Black Women and HIV in Northeast Texas
HIV/STD - 886
Electronic File
E13-13495
Black Women and HIV in Houston
HIV/STD - 886
Electronic File
E13-13144
Texas HIV Case Management Project: An Exploration of Current Thinking and Practice
HIV/STD - 783
Electronic File
E13-13494
Black Women and HIV in Fort Worth
HIV/STD - 886
Electronic File
E13-12373
Texas Statewide Coordinated Statement of Need
HIV/STD Epi & Surveillance - 613
Electronic File
E13-13491
Black Women and HIV in the Golden Triangle
HIV/STD - 886
Electronic File
E13-13498
Black Women and HIV in TDCJ
HIV/STD - 886
Electronic File
E13-13263
HIV, Syphilis and Hepatitis B Testing for Pregnant Women
HIV/STD - 783
Electronic File
E13-13279
Hispanics in Texas: Late HIV Diagnosis and Out of Care
HIV/STD - 783
Electronic File
E13-13312
HIV Testing and the Law
HIV/STD - 783
Electronic File
E13-13341
HIV Testing in County Jails
HIV/STD - 332
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 3 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E13-13369
Texas HIV/STD Prevention Community Planning Group: Questions and Answers
HIV/STD - 852
Electronic File
E13-13342
InSpot Texas poster
HIV/STD - 332
Electronic File
E13-13343
InSpot Texas palm card
HIV/STD - 332
Electronic File
E13-13350
HIV/AIDS among African-Americans in Texas
HIV/STD - 783
Electronic File
E13-13359
African American Women and HIV in Texas
HIV/STD - 332
Electronic File
E13-13493
Black Women and HIV in Dallas
HIV/STD - 886
Electronic File
E13-11889
Texas HIV/STD InfoLine Community Calls Program
HIV/STD - 449
Electronic File
STD-43
Referral / Risk Reduction Step Form
HIV/STD - 561
Forms
E13-11720
Texas HIV/STD E-Update
HIV/STD - 377
Electronic File
E13-11813
Texas HIV Medication Program Client Application
HIV/STD - 410
Electronic File
E13-11814
Texas HIV Medication Program Medical Eligibility Form
HIV/STD - 410
Electronic File
E4-152
Information for Persons with Negative HIV Antibody Tests
HIV/STD - 332
Electronic File
E13-11883
Prevention Counseling Quality Assurance Standards and Tools
HIV/STD - 445
Electronic File
E13-11884
Texas Perinatal HIV Transmission Epidemiologic Profile
HIV/STD - 447
Electronic File
E4-151
Information about your HIV Antibody Test
HIV/STD - 332
Electronic File
E13-12832
Texas Medical Monitoring Project Newsletter
HIV/STD Epidemiology 732
Electronic Newsletter/Magazine
E4-148
HIV/AIDS and the Workplace
HIV/STD - 332
Electronic File
E4-153
Positive HIV Antibody Test Fact Sheet
HIV/STD - 332
Electronic File
E4-141
HIV/AIDS: Facts You Should Know
HIV/STD - 332
Electronic File
E4-113
Texas HIV/STD Community Resource Directory
HIV/STD - 332
Electronic File
E13-11898
HIV/AIDS Fact Sheet
HIV/STD - 449
Electronic File
E13-11907
Oral Sex and HIV Fact Sheet
HIV/STD - 449
Fact Sheets
E13-11908
The Risk of Eating Raw Oysters Fact Sheet
HIV/STD - 449
Fact Sheets
E13-11912
Spousal Notification Fact Sheet
HIV/STD - 449
Fact Sheets
E13-11918
Update on Seroconversion for HIV Infection
HIV/STD - 449
Fact Sheets
E13-11937
Texas HIV/AIDS Epidemiological Profiles
HIV/STD Epidemiologic Monitoring - 594
Electronic File
E13-13504
Black Women and HIV in Texas
HIV/STD - 886
Electronic File
E13-11885
Texas HIV/AIDS and STD Border Report, 2001
HIV/STD - 447
Electronic File
13-12832
Texas Medical Monitoring Project Newsletter
HIV/STD Epidemiology 731
Newsletters
Alcohol & Alcoholism / Alcohol y Alcoholismo TCADA-24
DWI Recidivism in Texas
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-51
Indicators of Alcohol and Drug Abuse In Texas
Mental Hlth/Sub Abuse 491
Electronic File
E6-54
Drinking When Pregnant Could Result in Fetal Alcohol Syndrome
Birth Defects Epi - 550
Electronic File
TCADA-3
Economic Costs of Alcohol and Drug Abuse in Texas
Mental Hlth/Sub Abuse 493
Electronic File
Allergies & Allergic Reactions / Alergias y Reacciones alergicas E04-12094
The Burden of Asthma in Texas 2000-2005 (Texas Asthma Report)
Adult Health - 231
Electronic File
E06-10109
Lactose Intolerance, No. 5
Nutrition Services - 199
Electronic File
E06-10108
Gluten Intolerance, No. 4
Nutrition Services - 199
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 4 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
Alzheimer's Disease / Enfermedad de Alzheimer E42-11105
Texas Council on Alzheimer's Disease and Related Disorders Biennial Report 2000
Adult Health - 231
Electronic File
E42-13351
2010-2015 Texas State Plan on Alzheimer's Disease
Adult Health - 860
Electronic File
E42-10500
Texas Alzheimer's News
Adult Health - 231
Electronic Newsletter/Magazine
E4-20-8
Alzheimer's Disease, Aging, Long Term Care, Infection Control, Fire Safety, Back Safety
Audiovisual Library - 196
Electronic File
42-10500
Texas Alzheimer's News
Adult Health - 173
Newsletters
Arthritis / Artritis E91-13161
Texas Arthritis Program Brochure
Arthritis Program - 807
Electronic File
E91-13146
2009-2014 Arthritis State Plan
Arthritis Program - 807
Electronic File
E19-13169
Arthritis in Hispanic Texans
Arthritis Program - 807
Electronic File
E19-13167
Arthritis in Non-Hispanic White Texans
Arthritis Program - 807
Electronic File
E16-11164
Texas Risk Factor Report
Behavioral Risk Factor Surveillance System - 223
Electronic Newsletter/Magazine
E19-13162
Texas Arthritis 2005 Burden Report
Arthritis Program - 807
Electronic File
E19-13170
2007 Texas Facts and Figures
Arthritis Program - 807
Electronic File
E19-13163
Arthritis Management Handout
Arthritis Program - 807
Electronic File
E19-13164
Burden of Arthritis in Texas
Arthritis Program - 807
Electronic File
E19-13165
Arthritis in Texas Women
Arthritis Program - 807
Electronic File
E19-13166
Arthritis in Texas Men
Arthritis Program - 807
Electronic File
E91-11859
Texas Task Force on Arthritis 2003 Action Plan
Arthritis Program - 462
Electronic File
E19-13168
Arthritis in African-American Texans
Arthritis Program - 807
Electronic File
Automobile Safety / Seguridad en los automoviles E4-20-19
Automobile Safety Mini-catalog
Audiovisual Library - 196
Electronic File
E3-1
Epilepsy and Driving
Epilepsy Services - 427
Electronic File
Bioterrorism / Bioterrorismo E19-12065
Anthrax and Bioterrorism
External Relations Communications - 588
Electronic File
E19-12068
Plague and Bioterrorism
External Relations Communications - 588
Electronic File
E19-11984
Barriers to and Facilitators of Effective Risk Communication Bioterrorist Attack or Outbreak
External Relations Communications - 589
Electronic File
E19-12069
Smallpox and Bioterrorism
External Relations Communications - 588
Electronic File
E14-12843
Chemical Threat Response in Texas
Labs - 579
Electronic File
E19-12070
Tularemia and Bioterrorism
External Relations Communications - 588
Electronic File
Prepare-HSR01
Preparedness Resources Manual
HSR 1 - Public Health Preparedness - 160
Electronic File
E19-12066
Bioterrorism Preparedness and Response (FAQs)
External Relations Communications - 588
Electronic File
E19-12071
Viral Hemorrhagic Fevers and Bioterrorism
External Relations Communications - 588
Electronic File
E19-12067
Botulism and Bioterrorism
External Relations Communications - 588
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 5 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
50-11436
Preparedness Planning Review (Bioterrorism Planning Review Newsletter)
HSR 1 - Public Health Preparedness - 159
Newsletters
E19-12342
Colds, Flu and Anthrax Comparison
External Relations Communications - 588
Electronic File
E19-12343
Outlook on Bioterrorism: A Survey of Texans
External Relations Communications - 589
Electronic File
E50-11436
Preparedness Planning Review (Bioterrorism Planning Review Newsletter)
HSR 1 - Public Health Preparedness - 160
Electronic Newsletter/Magazine
E11-11161
Anthrax Vaccine-What You Need to Know - Vaccine Information Statement (VIS)
Immunization - 41
Electronic File
Birth Certificates & Vital Statistics / Actas de nacimiento y Estadisticas vitales EFVS-165
Suits Affecting Parent Child Relationship (Information on Suit Affecting the Family Relationship)
Vital Statistics - 760
Electronic File
EFVS-142.31
Application for Birth or Death Record - Certified (credit card) (Birth Certificate)
Vital Statistics - 346
Electronic File
EFVS-142.6
Mail Application for a Verification of a Birth or Death Record (Birth Certificate)
Vital Statistics - 346
Electronic File
EFVS-142.61
Application for Birth or Death Verification (credit card payment)
Vital Statistics - 346
Electronic File
EFVS-142.9
Mail Application for a Verification of Marriage and Divorce
Vital Statistics - 346
Electronic File
EFVS-143
Request for Identity of Court of Adoption
Vital Statistics - 346
Electronic File
EFVS-144
Heirloom Gift Certificate (Vital Statistics)
Vital Statistics - 346
Electronic File
EFVS-142.3
Mail Application for a Certified copy of a Birth or Death Record (Birth Certificate)
Vital Statistics - 346
Electronic File
EFVS-146
Application for an Heriloom Wedding Anniversary Certificate
Vital Statistics - 346
Electronic File
EFVS-134.1
Acknowledgement of Paternity Inquiry Request
Vital Statistics - 346
Electronic File
EFVS-166
Application for New Birth Certificate Based on Parentage
Vital Statistics - 346
Electronic File
EFVS-166.531
Adoption Validation Petition (for District Clerks)
Vital Statistics - 346
Electronic File
EFVS-166.532
Adoption Validation Order (for District Clerks)
Vital Statistics - 346
Electronic File
EFVS-168
Inquiry on Court of Continuous Jurisdiction for a Child
Vital Statistics - 760
Electronic File
EFVS-170
Application to Amend Certificate of Birth (Birth Certificate)
Vital Statistics - 346
Electronic File
EFVS-145
Adult Adoptee Application for Non-Certified copy of Original Birth Certificate
Vital Statistics - 346
Electronic File
EFVS-115
Report of Death
Vital Statistics - 759
Electronic File
EFVS-271
Application for Disinterment Permit (Vital Statistics)
Vital Statistics - 346
Electronic File
adop-court
Request for Identity of Court of Adoption
Vital Statistics - 71
Electronic File
E35-10559
Texas Vital Statistics Annual Report
Center for Health Statistics - 107
Electronic File
E35-12914
Quick Reference Guide to Electronic Medical Certification: Texas Electronic Registrar (TER)
Vital Statistics - 757
Electronic File
EBVS013
Vital Statistics Annual Report 1998
Center for Health Statistics - 107
Electronic File
EFVS-100
Requisition for Texas Vital Statistics Forms
Vital Statistics - 71
Electronic File
EFVS-142.21
Expedited Application for Birth or Death Record - Certified (credit card)(Birth Certificate)
Vital Statistics - 346
Electronic File
EFVS-109.2
Medical Data Worksheet for Child's Birth Certificate
Vital Statistics - 758
Electronic File
EFVS-172
Application to Amend Certificate of Death
Vital Statistics - 346
Electronic File
EFVS-130
Notice of Intent to Claim Paternity
Vital Statistics - 760
Electronic File
EFVS-131
Paternity Registry Notice of Change of Information
Vital Statistics - 760
Electronic File
Revocation of Notice of Intent to Claim Paternity
Vital Statistics - 760
Electronic File
EFVS-132
Stock #4-25-lang Revised 10/25/2010
Page 6 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EFVS-133
Denial of Registrants' Paternity
Vital Statistics - 760
Electronic File
EFVS-141
Application for Certified Copy of Birth or Death Certificates (Birth Certificate)
Vital Statistics - 760
Forms
EFVS-142.2
Expedited Application for a Certified copy of a Birth or Death Record (fax) (Birth Certificate)
Vital Statistics - 346
Electronic File
EFVS-109.1
Mother's Worksheet for Birth Certificate (2005)
Vital Statistics - 758
Electronic File
FVS-111
Certificate of Birth (2005) Long form (restricted distribution) (Birth Certificate)
Vital Statistics - 71
Forms
FVS-134
Paternity Registry Inquiry Request
Vital Statistics - 71
Forms
FVS-132
Revocation of Notice of Intent to Claim Paternity
Vital Statistics - 71
Forms
FVS-131
Paternity Registry Notice of Change of Information
Vital Statistics - 71
Forms
FVS-130
Notice of Intent to Claim Paternity
Vital Statistics - 71
Forms
FVS-128
Court-Ordered Delayed Certificate of Death
Vital Statistics - 71
Forms
FVS-115
Report of Death
Vital Statistics - 71
Forms
FVS-134.1
Acknowledgement of Paternity Inquiry Request
Vital Statistics - 71
Forms
FVS-112
Certificate of Death
Vital Statistics - 71
Forms
FVS-116
Burial-Transit Permit (restricted distribution)
Vital Statistics - 71
Forms
EFVS-2318.1A
Application for Amended Birth Certificate based on a Court Ordered Name Change
Vital Statistics - 346
Electronic File
FVS-109.2
Medical Data Worksheet for Child's Birth Certificate
Vital Statistics - 71
Forms
FVS-109.1
Mother's Worksheet for Birth Certificate (2005)
Vital Statistics - 71
Forms
FVS-101
Batch Control Form
Vital Statistics - 71
Forms
EFVS-180
Application for Marriage License
Vital Statistics - 760
Electronic File
EFVS-134
Paternity Registry Inquiry Request
Vital Statistics - 346
Electronic File
EFVS-271.1
Disinterment Consent Form (Vital Statistics)
Vital Statistics - 346
Electronic File
EFVS-301
Certificate of Birth Resulting in Stillborn Application (Birth Certificate)
Vital Statistics - 346
Electronic File
FVS-271.1
Disinterment Consent Form (Vital Statistics)
Vital Statistics - 71
Forms
EFVS-180.1
Declaration and Registration of Informal Marriage
Vital Statistics - 760
Electronic File
TER-Death
Texas Electronic Registrar (TER) - Internet-Based Death Registration
Vital Statistics - 759
Electronic File
FVS-113
Certificate of Fetal Death
Vital Statistics - 71
Forms
FVS-301
Certificate of Birth Resulting in Stillborn Application (Birth Certificate)
Vital Statistics - 71
Forms
FVS-140
Authorization Form to Issue Birth/Death Certificates (Birth Certificate)
Vital Statistics - 71
Forms
FVS-271
Application for Disinterment Permit (Vital Statistics)
Vital Statistics - 71
Forms
FVS-2318.1A
Application for Amended Birth Certificate based on a Court-Ordered Change of Name
Vital Statistics - 71
Forms
FVS-180.1
Declaration and Registration of Informal Marriage
Vital Statistics - 71
Forms
FVS-180
Application for Marriage License
Vital Statistics - 71
Forms
FVS-174
Amendment to Medical Certification of Certificate of Death
Vital Statistics - 71
Forms
FVS-141.4
Genealogical Sheet
Vital Statistics - 71
Forms
FVS-172
Application to Amend Certificate of Death
Vital Statistics - 71
Forms
FVS-141
Application for Certified Copy of Birth or Death Certificates (Birth Certificate)
Vital Statistics - 71
Forms
FVS-165
Suits Affecting Parent Child Relationship (Information on Suit Affecting the Family Relationship)
Vital Statistics - 71
Forms
Stock #4-25-lang Revised 10/25/2010
Page 7 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
FVS-166
Application for Amended Birth Certificate Based on Parentage
Vital Statistics - 71
Forms
FVS-168
Inquiry on Court of Continuous Jurisdiction for a Child
Vital Statistics - 71
Forms
Application to Amend Certificate of Birth (Birth Certificate)
Vital Statistics - 71
Forms
FVS-170
Birth Defects / Defectos al nacimiento E58-10957D
Birth Defect Risk Factor Series: Down Syndrome
Birth Defects Epi - 324
Electronic File
58-10955
Texas Birth Defects Monitor: A Semiannual Data and Research Update
Birth Defects Epi - 110
Newsletters
E58-10957J
Birth Defect Risk Factor Series: Oral Clefts
Birth Defects Epi - 324
Electronic File
E58-10957I
Birth Defect Risk Factor Series: Omphalocele
Birth Defects Epi - 324
Electronic File
E58-10957H
Birth Defect Risk Factor Series: NTDs
Birth Defects Epi - 324
Electronic File
E58-10957G
Birth Defect Risk Factor Series: Hydrocephaly
Birth Defects Epi - 324
Electronic File
E58-10957L
Birth Defect Risk Factor Series: Trisomy 18
Birth Defects Epi - 324
Electronic File
E58-10957E
Birth Defect Risk Factor Series: Gastroschisis
Birth Defects Epi - 324
Electronic File
E58-10957M
Birth Defect Risk Factor Series: Anal Atresia
Birth Defects Epi - 324
Electronic File
E58-10957C
Birth Defect Risk Factor Series: Diaphragmatic Hernia
Birth Defects Epi - 324
Electronic File
E58-10957B
Birth Defect Risk Factor Series: Craniosynostosis
Birth Defects Epi - 324
Electronic File
E58-10955
Texas Birth Defects Monitor: A Semiannual Data and Research Update
Birth Defects Epi - 169
Electronic Newsletter/Magazine
E58-10827
Birth Defects Glossary
Birth Defects Epi - 169
Electronic File
E58-10772
Report of Birth Defects Among 1996-1997 Deliveries
Birth Defects Epi - 210
Electronic File
BirthDefects95
Report of Birth Defects Among 1995 Deliveries
Birth Defects Epi - 210
Electronic File
E58-10957F
Birth Defect Risk Factor Series: Holoprosenchephaly
Birth Defects Epi - 324
Electronic File
E58-10957V
Birth Defect Risk Factor Series: 47,XXX
Birth Defects Epi - 324
Electronic File
RioGran96
1996 Birth Defects in the Lower Rio Grande Valley-A Special Report
Birth Defects Epi - 210
Electronic File
E6-240
Report of Birth Defects among 1999-2001 Deliveries
Birth Defects Epi - 210
Electronic File
E58-12507
Birth Defects in Top 20 Counties
Birth Defects Epi - 169
Electronic File
E58-12309
Report of Birth Defects among 1999-2002 Deliveries
Birth Defects Epi - 210
Electronic File
E58-11857
Report of Birth Defects Among 1999-2000 Deliveries
Birth Defects Epi - 210
Electronic File
E58-10957K
Birth Defect Risk Factor Series: Trisomy 13
Birth Defects Epi - 324
Electronic File
E58-10957W
Birth Defect Risk Factor Series: 47,XYY
Birth Defects Epi - 324
Electronic File
E58-10957N
Birth Defect Risk Factor Series: Atrial Septal Defect
Birth Defects Epi - 324
Electronic File
E58-10957U
Birth Defect Risk Factor Series: Turner Syndrome
Birth Defects Epi - 324
Electronic File
E58-10957T
Birth Defect Risk Factor Series: Triploidy
Birth Defects Epi - 324
Electronic File
E58-10957S
Birth Defect Risk Factor Series: Renal Agenesis
Birth Defects Epi - 324
Electronic File
E58-10957R
Birth Defect Risk Factor Series: Pyloric Stenosis
Birth Defects Epi - 324
Electronic File
E58-10957Q
Birth Defect Risk Factor Series: Intestinal Atresia/Stenosis
Birth Defects Epi - 324
Electronic File
E58-10957O
Birth Defect Risk Factor Series: Conotruncal Heart Defect
Birth Defects Epi - 324
Electronic File
E58-11040
Birth Defects Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E58-10957P
Birth Defect Risk Factor Series: Ear Defects
Birth Defects Epi - 324
Electronic File
Epidemiology/Injury Surveillance - 351
Electronic File
Brain Injury / Lesion cerebral E07-11640
Important First Steps
Stock #4-25-lang Revised 10/25/2010
Page 8 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E6-260
Texas Law: Health Benefit Plan Coverage for Treatment and Services after Brain Injury (brochure)
Epidemiology/Injury Surveillance - 351
Electronic File
E09-13172
Texas Traumatic Brain Injury (TBI) Hospitalizations, 2004-2007
Epidemiology/Injury Surveillance - 516
Electronic File
Breastfeeding / Alimentacion con pecho Bulletin Board
13-06-12408-2
Breastmilk is easier for your baby to digest (Restricted to WIC Local agencies)
E13-46
Mother's Milk For Premature Babies
Nutrition Services - 570
Electronic File
E13-27-3
Breastfeeding Promotion and Support Module- Part 3: Answer Key
Nutrition Services - 205
Electronic File
E13-06-11342
WIC Breastfeeding Peer Counselor Training Manual - For the Counselor
Nutrition Services - 150
Electronic File
E13-53
Just for Dad
Nutrition Services - 809
Electronic File
E13-58
Become a Mother-Friendly Worksite (Employer Support for Breastfeeding Moms)
Nutrition Services - 809
Electronic File
E13-6
Contraception and Breastfeeding, No. 18
Nutrition Services - 199
Electronic File
EBF-000-08
Benefits of Breastfeeding
Nutrition Services - 412
WIC Lesson/TrainingElectronic
13-06-12408-12
Get Breastfeeding Off to a Good Start (handout/questionnaire) (Restricted to WIC Local agencies)
13-25-1
Boy Crib Card
Nutrition Services - 885
Small card
E13-06-11289
Nursing More Than One
Nutrition Services - 570
Electronic File
E13-06-11288
Just For Grandparents
Nutrition Services - 809
Electronic File
E13-06-11236
Weaning from the Breast
Nutrition Services - 570
Electronic File
E13-06-11018
Normal Breast Fullness, Engorgement, Plugged Ducts, and Breast Infections, No. 22
Nutrition Services - 199
Electronic File
E13-06-11017
Oversupply Syndrome and Over-active Let-down Reflex, No. 21
Nutrition Services - 199
Electronic File
13-06-12408-5
Breastfeeding is Convenient (Restricted to WIC Local Agencies)
Electronic File
Bulletin Board
Bulletin Board
E13-27-1
Breastfeeding Promotion and Support Module Training Guide Workbook
Nutrition Services - 205
E13-06-10954
An Instructional Guide for Giving Your Baby the Best
Nutrition Services - 570
Electronic File
E13-206
Hand Expression and Storage of Breastmilk
Nutrition Services - 809
Electronic File
13-06-12408-11
Breastfeeding Lesson Survey Form - Participant (Restricted to WIC Local agencies)
Bulletin Board
13-06-12233
How to tell if your newborn is getting enough breastfmilk (Restricted to WIC Local Agencies)
Magnets
F13-06-13104A
Como puedo saber si va bien la lactancia materna (How Do I Know Breastfeeding Is Going Well?)
Forms
F13-06-13104
How Do I Know Breastfeeding Is Going Well?
Forms
F13-06-13103
Breast Pumping Log
Forms
F13-06-13102
Breastfeeding Assessment and Counseling Form
Forms Forms
F13-06-13101
Breastfeeding Follow-up Form
EWIC-50
Single-User Breast Pump Release Form
Nutrition Services - 307
Electronic File
EF13-06-13101
Breastfeeding Follow-up Form
Nutrition Services - 809
Electronic File
EWIC-51
Multi-User Breast Pump Loan/Release Form
Nutrition Services - 307
Electronic File
13-06-11934
I'm A Proud Dad (poster)
Posters
WIC-50
Single-User Breast Pump Release Form (Restricted to WIC local agencies)
Forms
13-06-12076
As a Doctor, I Support Breastfeeding (poster)
Posters
Stock #4-25-lang Revised 10/25/2010
Page 9 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information) Nutrition Services - 809
Electronic File
E13-06-11496
Breastfeeding and Working Works for Me (brochure)
13-06-12286
Breastmilk: 100% Natural Ingredients (Bag) (restricted to WIC Local Agencies)
Bag
13-06-12287
Breastmilk: 100% Natural Ingredients (Bib) (restricted to WIC Local Agencies)
Infant Bib
13-06-12408
Breastfeeding-because your baby deserves the very best (cover sheet) (Restricted distribution)
Bulletin Board
13-06-12408-1
Breastfeeding-because your baby deserves the very best (Title Piece) (limited distribution)
Bulletin Board
EBF-000-09
Giving You the Best That I Got, Baby
13-06-12408-4
Planning to Return to Work or School? (Restricted to WIC Local agencies)
Bulletin Board
WIC-51
Multi-User Breast Pump Loan/Release Form (Restricted to WIC local agencies)
Forms
E13-06-11934
I'm A Proud Dad (poster)
13-06-12408-10
Breastfeeding-because your baby deserves the very best (staff survey) (limited distribution)
Bulletin Board
13-06-12075
Act Natural..Breastfeed (poster)
Posters
13-06-12409-3
Breastfeeding-because your baby deserves the very best (horiz bordershoes) (limited distribut)
Bulletin Board
E13-06-12554
Community Action Kit for Protecting, Promoting, and Supporting Breastfeeding
Nutrition Services - 684
Electronic File
E13-06-12114
Steps to a Breastfeeding-Friendly Practice
Nutrition Services - 506
Electronic File
E13-06-12081
Support Your Partner
Nutrition Services - 570
Electronic File
E13-06-12080
Support Your Daughter
Nutrition Services - 570
Electronic File
E13-06-10830
License to Breastfeed in Public Card
Nutrition Services - 570
Electronic File
13-06-12408-9
Breastfeeding-because your baby deserves the very best (sample layout) (limited distribution)
Bulletin Board
13-06-12408-3
Breastfeeding is Healthy for Mothers (Restricted to WIC Local agencies)
Bulletin Board
E13-06-12077
Doctors Make the Difference, Incorporating Breastfeeding into Prenatal Care
13-06-12409
Breastfeeding-because your baby deserves the very best (borders) (Restricted distribution)
E13-06-13120
The Hospital Experience: What to Expect and How to Make it Memorable
13-06-12409-2
Breastfeeding-because your baby deserves the very best (horiz borderbear) (Restricted distribut)
E13-06-12076
As a Doctor, I Support Breastfeeding (poster)
Nutrition Services - 570
Electronic File
13-25
Girl Crib Card
Nutrition Services - 885
Small card
13-06-12409-4
Breastfeeding-because your baby deserves the very best (verticalshoes/bear) (limited distribut)
Bulletin Board
13-06-12409-5
Breastfeeding-because your baby deserves the very best (verticalrattle/duck) (limited distribut)
Bulletin Board
Nutrition Services - 412
Nutrition Services - 570
Nutrition Services - 506
WIC Lesson/TrainingElectronic
Electronic File
Electronic File Bulletin Board
Nutrition Services - 809
Electronic File Bulletin Board
13-186
Ask about our WIC Breast Pump Program (Poster)
Posters
13-06-12409-6
Breastfeeding-because your baby deserves the very best (verticalbutterfly/bear) (limited distribut)
Bulletin Board
13-06-13404
Breastfeeding-Friendly Establishment (window clings) (restricted to WIC Local Agencies)
Window clings
13-06-12409-7
Breastfeeding-because your baby deserves the very best (verticalbutterfly/duck) (limited distribut)
Bulletin Board
Stock #4-25-lang Revised 10/25/2010
Page 10 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information) Nutrition Services - 809
Format Electronic File
E13-06-12079
Your Baby, Your Gift
13-06-13393
Breastfeeding Logo (stickers)
Stickers
13-06-12409-1
Breastfeeding-because your baby deserves the very best (horiz borderpacifier) (limited distribut)
Bulletin Board
13-25-3
Boy NICU Crib Card
Nutrition Services - 885
Small card
E13-102
Give Your Baby the Best Start
Nutrition Services - 570
Electronic File
E13-101
Family Planning and Breastfeeding
Nutrition Services - 809
Electronic File
E13-140
WIC Breastfeeding Peer Counselor Training Manual - For the Instructor
Nutrition Services - 150
Electronic File
E13-06-12038
How Do I Know if I am Making Enough Milk?
Nutrition Services - 570
Electronic File
E13-06-13180
WIC Breastfeeding Peer Counselors: The Support Your Patients Need for Breastfeeding Success
Nutrition Services - 809
Electronic File
E13-159
Texas Position Statement on Infant Feeding
Nutrition Services - 506
Electronic File
13-06-12408-7
Picture of baby breastfeeding (Restricted to WIC Local agencies)
Electronic File
Bulletin Board
E13-167
Lactation Support Directory (Lactation Support Resource Directory)
Nutrition Services - 506
E13-06-13183
Breastfeeding: The Best Medicine You Can Prescribe
Nutrition Services - 804
Electronic File
E1-120
Monthly Prenatal Fact Sheets
Perinatal/Maternal/Child 446
Electronic File
E13-179
Breastfeeding in Public
Nutrition Services - 809
Electronic File
E13-184
Mother's Milk: It's More Than Just Food
Nutrition Services - 809
Electronic File
13-6
Contraception and Breastfeeding, No. 18 (Restricted to WIC Local Agencies)
E13-06-13331
Breastfeeding Beyond Six Months?
Nutrition Services - 809
Electronic File
E13-06-12075
Act Natural..Breastfeed (poster)
Nutrition Services - 570
Electronic File
13-06-12408-8
Picture of mother and baby looking at each other while breasfeeding (Limited to WIC Local agencies)
E13-06-13181
Become a WIC Breastfeeding Peer Counselor
Nutrition Services - 809
Electronic File
E13-06-13182
WIC Peer Counselors: The Support You Need to Successfully Breastfeed
Nutrition Services - 809
Electronic File
E13-185
Physician's Pocket Guide to Breastfeeding
Nutrition Services - 506
Electronic File
13-25-2
Girl NICU Crib Card
Nutrition Services - 885
Small card
Breastfeeding the Sleepy Newborn, No. 19
Nutrition Services - 199
Electronic File
E06-10495
Fact Sheets
Bulletin Board
Cancer / Cancer E10-13121
The Cost of Cancer in Texas, 2007
Cancer Epi/Surv - 111
Electronic File
E10-66
Breast and Cervical Cancer Services (BCCS) Brochure
Breast & Cervical Cancer 749
Electronic File
E10-53
Living With Your Own Decision: Facts about Prostate Cancer Screening for the Hispanic Man
Adult Health - 231
Electronic File
E10-52
Is Prostate Cancer Screening For Me?
Adult Health - 231
Electronic File
E10-51
Prostate Cancer Screening: Facts for the African American Man
Adult Health - 231
Electronic File
E10-15J
ABCs of Health - Tobacco
Adult Health - 231
Electronic File
E10-15D
ABCs of Health - Cancer
Adult Health - 231
Electronic File
E10-15B
ABCs of Health - Breast Examination and Mammogram/Pap Test
Adult Health - 231
Electronic File
EF10-13427
WS_FTP User Information Form
Cancer Epi/Surv - 870
Electronic File
E10-13439
Colorectal Cancer in Texas, 2010
Cancer Epi/Surv - 111
Electronic File
E10-13294
Cancer in Texas, 2009
Cancer Epi/Surv - 833
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 11 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E10-10921
Prostate Cancer in Texas
Cancer Epi/Surv - 111
Electronic File
10-10542
Texas Cancer Reporting News
Cancer Epi/Surv - 61
Newsletters
10-10543
Cancer Registry Bookmark
Cancer Epi/Surv - 61
Bookmarks
E10-10272
Texas Cancer Registry Brochure
Cancer Epi/Surv - 111
Electronic File
E10-10527
Selected Cancer Facts-PHR 1 - 11
Cancer Epi/Surv - 111
Electronic File
E25-12470
The Cost of Cancer in Texas
Tx Hlth Care Info Collection - 301
Electronic File
E44-11112
The Cost of Cancer in Texas
Comprehensive Cancer Control - 212
Electronic File
E10-10539
Cancer in Texas (Cancer Incidence Report)
Cancer Epi/Surv - 111
Electronic File
E10-10542
Texas Cancer Reporting News
Cancer Epi/Surv - 111
Electronic Newsletter/Magazine
TCR-1
Confidential Cancer Reporting Form
Cancer Epi/Surv - 244
Electronic File
E10-10677
Cancer Reporting Handbook
Cancer Epi/Surv - 244
Electronic File
E10-12820
Cancer Incidence & Mortality in Texas, 1999-2003
Cancer Epi/Surv - 111
Electronic File
E10-11701
Commonly Used Variables from the Texas Cancer Registry
Cancer Epi/Surv - 369
Electronic File
E10-11756
Cancer Registry Electronic Submission System (CRESS) Instructions
Cancer Epi/Surv - 244
Electronic File
E10-12060
Selected Cancer Facts, Texas Counties
Cancer Epi/Surv - 111
Electronic File
EF10-11698
Request for Confidential Cancer Registry Data
Cancer Epi/Surv - 369
Forms
E10-12224
Tobacco and Cancer in Texas
Cancer Epi/Surv - 111
Electronic File
E10-12424
SANDCRAB Lite for Pathlabs User's Manual (restricted to SANDCRAB users)
Cancer Epi/Surv - 636
Electronic File
E10-10668
Sandcrab Lite 3.1 User's Guide
Cancer Epi/Surv - 111
Electronic File
EF10-13428
WS_FTP Use and Confidentiality Statement
Cancer Epi/Surv - 870
Electronic File
E10-10662
Texas Cancer Registry Quality and Assurance Flyer
Cancer Epi/Surv - 111
Electronic File
E45-12285
Texas Cancer Control Toolkit
Comprehensive Cancer Control - 576
Electronic File
E81-11194
Texas Chronic Disease Burden Report
Chronic Disease - 859
Electronic File
E6-4
Cancer Cluster Brochure
Cancer Epi/Surv - 111
Electronic File
E44-11957
Comprehensive Cancer Control in Texas: 1998-2002 Final Report
Comprehensive Cancer Control - 212
Electronic File
E10-66A
Cancer de mama y de cuello de utero servicios folleto (Breast/Cervical Cancer Services brochure
Breast & Cervical Cancer 749
Electronic File
E44-11185
Prostate Cancer Advisory Committee Biennial Report
Adult Health - 231
Electronic File
Case Management / Administracion de casos CPW-06
Prior Authorization Request for Additional Visits
Case Management - 309
Electronic File
CM-Pol
Case Management Policy Clarification Form
Case Management - 309
Electronic File
CPW-01
CPW Initial Prior Authorization Request (formerly Case Management Intake/Enrollment)
Case Management - 309
Electronic File
CPW-02
Case Management Family Needs Assessment
Case Management - 309
Electronic File
CPW-02A
Case Management Migrant Information Form
Case Management - 309
Electronic File
CPW-04
Case Management Follow-up Form
Case Management - 309
Electronic File
CPW-05
Case Management Progress Notes
Case Management - 309
Electronic File
CM-Intake
Non-medicaid Case Management Intake Form
Case Management - 309
Electronic File
CPW-06A
Request to Change Authorization to Another Case Manager
Case Management - 309
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 12 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
CPW-10
Case Management Notification Of Significant Provider Changes
Case Management - 309
Electronic File
CPW-11
Case Management Record Of CPW Billed Services
Case Management - 309
Electronic File
CPW-12
Case Management Authorization to Disclose Protected Health Information
Case Management - 309
Electronic File
CPW-04A
Case Management Follow-up Documentation Continued
Case Management - 309
Electronic File
Child Abuse / Abuso infantil E20-12398
Youth Camp Approved Training Programs (Sexual Abuse & Child Molestation)
Environ/Consumer Safety 616
Electronic File
62-10692
Tx Resource: the Official Newsletter of the Council on Sex Offender Treatment
Council on Sex Offender Treatment - 118
Newsletters
E75-11987
Abortion Facility Personnel Training on Recognizing and Reporting Child Abuse
Abortion Facility Licensing - 470
Electronic File
F62-10689
Reg Sex Offender Treatment Prov/Affiliate Sex Offender Treatment Prov Appl
Council on Sex Offender Treatment - 118
Forms
Child Development / Desarrollo infantil E06-10256
Reading to Children, No. 13
Nutrition Services - 199
Electronic File
E05-02233
Hypothyroidism and Your Infant
Newborn Screening - 317
Electronic File
E1-66
So Your Baby Has the Sickle Cell Trait
Newborn Screening - 313
Electronic File
Childbirth / Parto F66-10716
Midwife Documentation Application
Midwifery Program - 124
Forms
F66-10715
Midwife - Newborn Screening Test Objection Form
Midwifery Program - 124
Forms
EF66-10717
Midwife Informed Choice and Disclosure Statement
Midwifery Program - 671
Electronic File
E66-10720
The Texas Midwifery Basic Information and Instructor Manual
Midwifery Program - 671
Electronic File
E58-11040
Birth Defects Audiovisual Catalog
Audiovisual Library - 196
Electronic File
F66-10717
Midwife Informed Choice and Disclosure Statement
Midwifery Program - 124
Forms
E1-120
Monthly Prenatal Fact Sheets
Perinatal/Maternal/Child 446
Electronic File
E66-10555
Texas Midwifery Board Midwifery Rules
Midwifery Program - 671
Electronic File
F66-10718
Midwife Training Certification Form - Newborn Screening Specimen Collection
Midwifery Program - 124
Forms
E58-10827
Birth Defects Glossary
Birth Defects Epi - 169
Electronic File
F66-10719
Newborn Screening Agreement for Newborn Babies of Midwife Clients
Midwifery Program - 124
Forms
Children - Care & Hygiene / Ninos--su cuidado e higiene personal 13-06-12579
Zobey Magnet: Did You Know that Children Need (Restricted to WIC local agencies)
Magnets
13-06-12262
Hey Look What I can Do (poster)
Posters
E59-11510
The Anti-Bs Coloring Sheet - "We're the Anti-Bs"
Infectious Disease - 602
Coloring Books
E50-10873
Literature Review - Women's Health/Children's Health
HSR 1 - 394
Electronic File
E59-11769
Appropriate Antibiotic Use Campaign - PTA Media Kit
Infectious Disease - 400
Electronic File
E06-10324
Constipation in Infancy and Childhood, No. 14
Nutrition Services - 199
Electronic File
E05-12577
Texas Child Fatality Review Team Post
Title V-Child Fatality Review - 691
Electronic File
ECD-0016
Texas Guide to School Health Programs
School Health Program 519
Electronic File
06-10325
Diarrhea in Infancy and Early Childhood, No. 15 (Restricted to WIC Local Agencies)
Stock #4-25-lang Revised 10/25/2010
Fact Sheets
Page 13 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
EPSDT-15
Case Management for Children and Pregnant Women (Case Management Poster) 8-1/2" x 11"
Texas Health Steps - 24
Electronic File
EPSDT-13
Visits to the Doctor and Dentist (Appointment Education Poster (16" x 20")
Texas Health Steps - 24
Posters
E05-03876
Pneumococcal Infection and Penicillin
Newborn Screening - 313
Electronic File
E05-06069
Vision and Hearing Requirements and Procedures
Vision, Hearing and Spinal Screening - 65
Electronic File
E05-10632
The Child with Mild Hyperphenylalanemia
Newborn Screening - 281
Electronic File
13-06-12365-6
Child's Play Bulletin Board pieces - Baby with Toys picture
E45-12083
Weight Management Algorithm for Overweight Children and Adolescents
Texas Diabetes Council 197
Electronic File
E1-206
Congenital Adrenal Hyperplasia: A Handbook for Parents
Newborn Screening - 282
Electronic File
E1-94
Vision Pamphlet
Vision, Hearing and Spinal Screening - 372
Electronic File
E59-11511
A Guide for Parents - Get Smart about Antibiotics
Infectious Disease - 602
Electronic File
E59-11765
Information on Staphylococcal Infections for Day Care Administrators & Care Givers
Infectious Disease - 400
Electronic File
EPSDT-12
Checkups Poster (Texas Health Steps)
Texas Health Steps - 24
Electronic File
06-10324
Constipation in Infancy and Childhood, No. 14 (Restricted to WIC Local Agencies)
E05-12889
Coordinated School Health Program-Guide for Texas School Districts
School Health Program 743
Electronic File
E56-11815
Assessment of Parasitic Disease in Children in Five Communities in the Border Region-Far West Texas
HSR 9/10 - 584
Electronic File
E06-10325
Diarrhea in Infancy and Early Childhood, No. 15
Nutrition Services - 199
Electronic File
E59-11509
There's No Excuse for Overuse (The Anti-B's!)
Infectious Disease - 602
Posters
Bulletin Board
Fact Sheets
Children - Nutrition / Ninos--su nutricion ECH-15
Dietary Recall and Assessment for Children 10 to 20, 24 Hours
Health Promotion - 642
Electronic File
E13-41
Preschool Nutrition Module Answer Key
Nutrition Services - 205
Electronic File
E13-06-11656
Dietary Recall and Assessment for Children 1 to 4, 24 Hours
Nutrition Services - 359
Electronic File
E13-06-11384
Inappropriate Feeding Practices for Children, No. 23
Nutrition Services - 199
Electronic File
E40464
Building Healthy Families
Communications- 517
Electronic File
E13-40
Preschool Nutrition Module
Nutrition Services - 205
Electronic File
E05-10451
A Teacher's Guide to Galactosemia
Newborn Screening - 318
Electronic File
E09-12948
Nitrates in Drinking Water, Is the Water Your Children Drink Safe?
Hlth Assessment/Toxicology 754
Electronic File
ECH-14
Dietary Recall and Assessment for Children 5 to 9, 24 Hours
Health Promotion - 642
Electronic File
E05-10450
A Teacher's Guide to PKU
Newborn Screening - 281
Electronic File
E05-10822
Galactosemia Food Card
Newborn Screening - 318
Electronic File
Children with Special Needs / Programa para ninos con necesidades especiales 07-12276
Children with Special Health Care Needs (CSHCN) Provider Bulletin
Children w/Special Health Care Needs - 681
Newsletters
EF07-13429
Client Drug Co-Pay Reimbursement Request Form/Solicitud del cliente para el reembolso del copago
Children w/Special Health Care Needs - 692
Electronic File
E41-13335
Title V Performance Measures
Children w/Special Health Care Needs - 847
Electronic File
E4-1
CSHCN Services Program (brochure)
Children w/Special Health Care Needs - 692
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 14 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E07-13111
Resource List for Transitioning Youth in Texas
Children w/Special Health Care Needs - 797
Electronic File
E07-12954
CSHCN Quick Reference Guide
Children w/Special Health Care Needs - 697
Electronic File
E07-12835
Family Support Services Provider Manual
Children w/Special Health Care Needs - 697
Electronic File
E07-12588
CSHCN Services Provider Manual - 2009
Children w/Special Health Care Needs - 697
Electronic File
E07-12481
Children with Special Health Care Needs (CSHCN) Services Program Rules
Children w/Special Health Care Needs - 652
Electronic File
E07-12276
Children with Special Health Care Needs (CSHCN) Provider Bulletin
Children w/Special Health Care Needs - 697
Electronic Newsletter/Magazine
07-12617
CSHCN Services Program poster
Children w/Special Health Care Needs - 681
Posters
E07-12153
What is a Medical Home? (Medical Home Brochure)
Children w/Special Health Care Needs - 512
Electronic File
E6-2
Colds
Infectious Disease - 183
Electronic File
E19-12148
Stop the Spread of Colds and Flu
Communications - 510
Electronic File
Colds / Resfrios
Communicable Diseases / Enfermedades transmisibles E59-11327
Salmonellosis
Infectious Disease - 183
Electronic File
E59-12432
Taking Care of Wounds that are Draining or Have Not Healed
Infectious Disease - 400
Electronic File
E59-11329
Vibrio parahaemolyticus
Infectious Disease - 183
Electronic File
E59-11314
Campylobacteriosis in Texas
Infectious Disease - 183
Electronic File
E59-11312
Home vs. Hospital Care Precautions for Antibiotic Resistant Bacteria
Infectious Disease - 400
Electronic File
E59-11364
Notifiable Conditions in Texas
Infectious Disease - 112
Electronic File
E59-11016
Facts about Meningococcal Meningitis (Invasive)
Infectious Disease - 183
Electronic File
E59-11328
Shigellosis
Infectious Disease - 183
Electronic File
E59-11316
Escherichia coli 0157:H7
Infectious Disease - 183
Electronic File
E59-12228
Antibiotic Use Do's and Don'ts
Infectious Disease - 602
Electronic File
E59-11868
Cholera (Vibrio cholerae)
Infectious Disease - 183
Electronic File
E59-11866
Botulism (Botulinum Toxins)
Infectious Disease - 183
Electronic File
E59-11871
Smallpox (Variola virus)
Infectious Disease - 183
Electronic File
E59-11872
Staphylococcal Enterotoxin B
Infectious Disease - 183
Electronic File
E59-11841
Epi Case Criteria
Infectious Disease - 112
Electronic File
E59-11874
Cyclospora Fact Sheet
Infectious Disease - 183
Electronic File
E59-12154
Guidelines for Preventing Spread of Multi-Drug Resistant Bacteria/Health Care Setting
Infectious Disease - 400
Electronic File
E59-12490
What You Need to Know About Staph/MRSA Skin Infections
Infectious Disease - 657
Electronic File
E59-12226
Antibiotic Resistance Questions and Answers
Infectious Disease - 602
Electronic File
E59-12493
Prevention, Treatment, and Containment of Methicillin-Resistant Staphy Infections in County Jails
Infectious Disease - 400
Electronic File
E59-12229
What You Should Know about using Antibiotics
Infectious Disease - 602
Electronic File
E59-11765
Information on Staphylococcal Infections for Day Care Administrators & Care Givers
Infectious Disease - 400
Electronic File
E59-12377
Name Three Things You Can Do to Prevent the Spread of Staph
Infectious Disease - 602
Electronic File
E59-11748
TxEDSS Data Entry Guide
Infectious Disease - 463
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 15 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E59-12378
Did You See a Spider?
Infectious Disease - 602
Electronic File
E59-11574
Invasive Streptococcal Disease Case Report
Infectious Disease - 185
Electronic File
E59-11366
Laboratory Results That Must Be Reported To the Local Health Authority
Infectious Disease - 430
Electronic File
E59-11768
Information on Staphylococcal Infections for School Athletic Depts
Infectious Disease - 400
Electronic File
CDC525
(CDC 52.5) Typhoid Fever Surveillance Report (CDC)
Infectious Disease - 185
Electronic File
E19-12368
What You Need to Know about Avian Influenza (Bird Flu)
External Relations Communications - 610
Electronic File
59-11509
There's No Excuse for Overuse (The Anti-B's!)
Infectious Disease - 35
Posters
E11-11530
Is it just a cough? Or is it pertussis/whooping cough
Immunization - 781
Electronic File
E11-11444
Client Brochure (Perinatal Hepatitis B)
TB Elimination - 855
Electronic File
E11-10951
Texas Child Care Facility Report of Immunization Status (annual)
Immunization - 786
Electronic File
E11-10950
The Upshot
Immunization - 167
Electronic File
E09-13459
Texas Influenza Sureveillance Handbook
Infectious Disease - 881
Electronic File
5-14P
Staph Crossword Puzzle Poster
Warehouse
Posters
E05-03876
Pneumococcal Infection and Penicillin
Newborn Screening - 313
Electronic File
5-13P
A Good Offense is Still the Best Defense
Warehouse
Posters
6-12P
Know Hepatitis C: Know the Facts, Not the Fears (Limit 20)
Warehouse
Posters
CD-001
Drug Therapy for Treatment of Hansen's Disease
Hansen's Disease - 83
Forms
6-30
Recommendations for the Prevention and Control of Communicable Disease in a Group-care (Limit 300)
Warehouse
Posters
C-91
Diphtheria, Tetanus, and Pertussis-What You Need to Know
Immunization - 710
Forms
6-310P
Know Your Exposure Control Plan
Warehouse
Posters
C-85
Pneumococcal Conjugate Vaccine-What You Need to Know (VIS)
Immunization - 710
Forms
6-31P
Know Your Exposure Control Plan (poster)
Infectious Disease - 35
Posters
59-11510
We're the Anti-B's (coloring sheet)
Infectious Disease - 35
Coloring Books
E59-12547
Health Care Provider Brochure
Infectious Disease - 683
Electronic File
E5-200
Cover Your Cough
Infectious Disease - 602
Electronic File
E5-14
Staph Crossword Puzzle Poster
Infectious Disease - 400
Electronic File
E5-13
A Good Offense is Still the Best Defense
Infectious Disease - 602
Electronic File
E5-100
MRSA Hygiene Awareness
Infectious Disease - 400
Electronic File
E50-10970
Zoonosis News from Health Service Region 1
HSR 1-Zoonosis - 604
Electronic Newsletter/Magazine
E25-11033
Texas Health Facts
Center for Health Statistics - 191
Electronic File
E19-13237
What You Need to Know about Isolation and Quarantine
Communications - 823
Electronic File
E11-12811
Little Kids Get the Flu Too
Immunization - 781
Electronic File
E19-12369
What You Need to Know about Flu (Influenza) and Pandemic Flu
External Relations Communications - 610
Electronic File
E59-10940
Epilink Online Bulletin (previously known as Disease Prevention News)
Infectious Disease - 166
Electronic File
11-11424
Pertussis (Whooping Cough) Fact Sheet/Pertusis (La tos fernia) hoja de informes
Immunization - 293
Fact Sheets
E7-27
Zoonoses
Zoonosis - 376
Electronic File
E19-12148
Stop the Spread of Colds and Flu
Communications - 510
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 16 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E19-12069
Smallpox and Bioterrorism
External Relations Communications - 588
Electronic File
E19-12065
Anthrax and Bioterrorism
External Relations Communications - 588
Electronic File
E19-11457
Communicable Disease Control Measures in Texas: A Guide for Hlth Authorities in Public Hlth Emerg
Regional & Local Svs - 321 Electronic File
E14-13224
Testing for H1N1 (Swine) Influenza Viruses by the Public Health Laboratories
Labs - 822
Electronic File
E19-12380
Pandemic Flu Key Points
External Relations Communications - 610
Electronic File
EF59-12608
Invasive Meningococcal (Neisseria meningitidis) Case Report
Infectious Disease - 185
Electronic File
EEPI-1
Infectious Disease Report (Communicable Disease Reporting Form)
Infectious Disease - 185
Electronic File
EEPI-2
Initial Provider Infectious Disease Report (Communicable Disease Reporting Form)
Infectious Disease - 185
Electronic File
EF11-10869
Mumps Case Track Record
Infectious Disease - 727
Electronic File
EF11-10870
Pertussis Case Track Record
Infectious Disease - 727
Electronic File
EF11-10871
Haemophilus Influenzae Case Track Record
Infectious Disease - 727
Electronic File
EF11-11046
Varicella (Chickenpox) Reporting Form
Infectious Disease - 727
Electronic File
EF12-11050
Foot Screen Record - Hansen's Disease
Infectious Disease - 629
Electronic File
EF12-11051
Hand Screen Record - Hansen's Disease
Infectious Disease - 629
Electronic File
EF59-10874
Antibiotic Resistant Isolate Reporting Form
Infectious Disease - 185
Electronic File
EF59-11350
Meningitis (Bacterial) Disease Investigation Form (Bacterial Meningitis and Bacteremia Case Report)
Infectious Disease - 185
Electronic File
ECD-010
Disclosure and Consent Skin Biopsy for Hansen’s Disease Cases or Suspects
Infectious Disease - 629
Electronic File
EF59-11355
Yersiniosis Reporting Form
Infectious Disease - 185
Electronic File
F50-12589
Infectious Disease Reporting Form
ERT-HSR 1 - 693
Forms
EF59-91102
Legionellosis Case Report (Legionnaires' Disease Reporting Form)
Infectious Disease - 185
Electronic File
EHD-400
Texas Hansen's Disease Encounter Form
Infectious Disease - 629
Electronic File
EHDC-400
Texas Hansen's Disease Suspect/Contact Screen
Infectious Disease - 629
Electronic File
E-Lister
What you should know about: Listeriosis (& listeriosis infection during pregnancy)
Infectious Disease - 183
Electronic File
F11-10949
Immunization Division Order Form
Immunization - 293
Forms
E59-12781
Creutzfeldt-Jakob Disease Case Report Form
Infectious Disease - 185
Electronic File
F59-91102
Legionellosis Case Report (Legionnaires' Disease Reporting Form)
Infectious Disease - 35
Forms
E7-16
The Wild Side of Rabies
Zoonosis - 376
Electronic File
HD-400
Texas Hansen's Disease Encounter Form
Hansen's Disease - 83
Forms
Smear/biopsy
Skin Smear/Biopsy Chart
Infectious Disease - 629
Electronic File
7-38
Plague Warning (poster)
Warehouse
Posters
EF59-11354
Cholera and Other Vibrio Illness Surveillance Report (Vibriosis Reporting Form)
Infectious Disease - 185
Electronic File
E6-5
Impetigo
Infectious Disease - 183
Electronic File
G-1A
Specimen Submission Form (Bacteriology Testing)
Labs - 388
Forms
E59-13147
Notifiable Conditions Information Card
Infectious Disease - 112
Electronic File
E6-10
Infection Control Manual for Ambulatory Care Clinics
Infectious Disease - 869
Electronic File
E6-101A
Required Reporting of Certain Diseases (Professional)
Infectious Disease - 112
Electronic File
E6-12P
Know Hepatitis C: Know the Facts, Not the Fears
Infectious Disease - 533
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 17 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information) Infectious Disease - 183
Electronic File
E6-2
Colds
E6-30
Communicable Disease Chart for Schools and Child-Care Centers
Infectious Disease - 631
Electronic File Electronic File
ECD-001
Drug Therapy for Treatment of Hansen's Disease
Infectious Disease - 629
E6-34
Pregnancy, Hepatitis B and Rubella Facts (If you are pregnant..)
Immunization - 151
Electronic File
E6-53
Antibiotic Resistance (Antibiotics Aren't Always the Answer)
Infectious Disease - 621
Electronic File
E6-7
Crypto (Cryptosporidiosis)
Infectious Disease - 183
Electronic File
E7-7
Encephalitis
Zoonosis - 376
Electronic File
EC-87
Live Intranasal Influenza Vaccine-What You Need to Know - VIS
Immunization - 781
Electronic File
E6-33
A Guide to the Diagnosis of Tick-Borne Diseases
Zoonosis - 376
Electronic File
EC-12
Texas Hansen’s Disease Surveillance Form and Case Report
Infectious Disease - 629
Electronic File
E6-8
Gastroenteritis
Infectious Disease - 183
Electronic File
E7-37
Hantavirus Pulmonary Syndrome
Zoonosis - 376
Electronic File
E7-36
Facts About Plague
Zoonosis - 376
Electronic File
E7-35
Lyme Disease
Zoonosis - 376
Electronic File
E59-12824
Prevention and Containment of Staphylococcal Infections in Communities
Infectious Disease - 400
Electronic File
E7-24
Rocky Mountain Spotted Fever
Zoonosis - 376
Electronic File
E7-15
Rabies-and How It Can Be Controlled
Zoonosis - 376
Electronic File
E7-14
Facts about Rabies
Zoonosis - 376
Electronic File
EC-84
2009 H1N1 Inactivated Influenza Vaccine - What You Need to Know (VIS)
Immunization - 41
Electronic File
Communication / Comunicacion F76-10789
St Bd Exam for Speech-Lang Pathology and Audiology - Application Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10798
Supervision Log - Speech-Language Pathology and Audiology
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10797
St Bd Exam for Speech-Lang Pathology and Audiology-Superv Resp Statement for Assts
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10796
St Bd Exam for Speech-Lang Pathology and Audiology - Report of Completed Internship Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10795
St Bd Exam for Speech-Lang Pathology and Audiology-Rec of Cont Educ Hrs Earned Used
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10793
St Bd Exam for Speech-Lang Pathology and Audiology - Intern Plan & Agreement of Sup Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10790
St Bd Exam for Speech-Lang Pathology and Audiology-Clinical Observ & Exp for Assts. Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10787
Speech-Language Pathology Course Work and Clinical Experience Form
State Bd of Examiners Speech & Audiology - 129
Forms
EORLIST
Open Records Checklist
Off. of Gen. Counsel - 115
Electronic File
E19-12072
Writing a Public Health Crisis and Emergency Risk Communication Plan
External Relations Communications - 589
Electronic File
E19-12064
Media Planning and Resource Guide
External Relations Communications - 589
Electronic File
E19-11984
Barriers to and Facilitators of Effective Risk Communication Bioterrorist Attack or Outbreak
External Relations Communications - 589
Electronic File
76-10794
St Bd Exam for Speech-Lang Pathology and Audiology Newsletter
State Bd of Examiners Speech & Audiology - 129
Newsletters
73-10823
The Communicator
Professional Licensing and Certification - 98
Newsletters
Stock #4-25-lang Revised 10/25/2010
Page 18 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F76-10792
St Bd Exam for Speech-Lang Pathology and Audiology-Fitting & Disp of Hearing Instr Reg
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10788
St Bd Exam for Speech-Lang Pathology and Audiology-Alt Meth for Assistant to Obtain Clinical Observ
State Bd of Examiners Speech & Audiology - 129
Forms
Community & Rural Health / Salud en la comunidad y Salud rural F21-13510
Promotor(a)/Community Health Worker Application for Certification
Community Hlth Wrkr 370
Forms
EF21-13513
Instructor Application for Certificate Renewal Promotor(a)/Community Health Worker
Community Hlth Wrkr 371
Electronic File
EF21-13512
Promotor(a)/Community Health Worker Application for Certificate Renewal
Community Hlth Wrkr 371
Electronic File
F21-13515
Training Program/Sponsoring Organization Application for Certificate Renewal
Community Hlth Wrkr 370
Forms
F21-13514
Training Program/Sponsoring Organization Application for Certification
Community Hlth Wrkr 370
Forms
F21-13513
Instructor Application for Certificate Renewal Promotor(a)/Community Health Worker
Community Hlth Wrkr 370
Forms
F21-13512
Promotor(a)/Community Health Worker Application for Certificate Renewal
Community Hlth Wrkr 370
Forms
EF21-13515
Training Program/Sponsoring Organization Application for Certificate Renewal
Community Hlth Wrkr 371
Electronic File
F12-13204
Texas Refugee Health Assessment Form
Refugee Health - 814
Forms
E24-11945
Promotor(a) or Community Health Worker Training and Certification Program - Annual Report
Community Hlth Wrkr 371
Electronic File
EF21-13511
Instructor Application for Certification - Promotor(a)/Community Health Worker
Community Hlth Wrkr 371
Electronic File
EF21-13510
Promotor(a)/Community Health Worker Application for Certification
Community Hlth Wrkr 371
Electronic File
EF12-13204
Texas Refugee Health Assessment Form
Refugee Health - 815
Electronic File
E80-10942
Indigent Health Care Program Handbook
Indigent Health Program 421
Electronic File
E45-10960
Type 2 Diabetes in Children and Adolescents Statewide Action Plan
Texas Diabetes Council 425
Electronic File
E24-13367
Annual Report Promotor(a) or Community Health Worker (CHW) Training and Certification Advisory 2009
Community Hlth Wrkr 851
Electronic File
F21-13511
Instructor Application for Certification - Promotor(a)/Community Health Worker
Community Hlth Wrkr 370
Forms
EF21-13514
Training Program/Sponsoring Organization Application for Certification
Community Hlth Wrkr 371
Electronic File
Epidemiology/Injury Surveillance - 351
Electronic File
Forms
Concussion / Conmocion E07-11640
Important First Steps
Consumer Health / Salud del consumidor G-22
Consumer Health Form
Warehouse
MH-1
Handbook of Consumer Rights Mental Health
Mental Health - 499
Electronic File
F47-11259
Complaint/Injury Report
Milk Group - 31
Forms
F47-11258
Report of Certification
Milk Group - 31
Forms
E09-12948
Nitrates in Drinking Water, Is the Water Your Children Drink Safe?
Hlth Assessment/Toxicology 754
Electronic File
E07-12153
What is a Medical Home? (Medical Home Brochure)
Children w/Special Health Care Needs - 512
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 19 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E06-10105
Fact Sheet No. 1: A Quick Consumer Guide to Safe Food Handling
Nutrition Services - 199
Electronic File
E02-12527
Licensed Mental Health Professionals in Texas-A Fact Sheet for Consumers
Professional Licensing and Certification - 677
Electronic File
E16-11192
Texas Tobacco Prevention Initiative Media Campaign & Comm. Progr. Effects Among Children & Adults
Substance Abuse Services - Electronic File Tobacco - 236
Dating / Salir con novios 1-184P
Clueless About Dating Violence?
Warehouse
Posters
1-185P
Guys, Do You Know How to Treat Your Date or Girlfriend Right?
Perinatal/Maternal/Child 76
Posters
Death & Dying / La muerte y el morirse E35-13062
Texas Electronic Registrar: A Quick Reference Guide to Electronic Death Registration
Vital Statistics - 757
Electronic File
E35-10559
Texas Vital Statistics Annual Report
Center for Health Statistics - 107
Electronic File
E81-11194
Texas Chronic Disease Burden Report
Chronic Disease - 859
Electronic File
E81-11195
Texas Plan to Reduce Cardiovascular Disease and Stroke
Cardiovascular Health and Wellness - 193
Electronic File
EBVS013
Vital Statistics Annual Report 1998
Center for Health Statistics - 107
Electronic File
EF01-11421
Department of State Health Services Standard Out-of-Hospital Do Not Resuscitate Order (DNR)
EMS - 292
Electronic File
EFVS-271
Application for Disinterment Permit (Vital Statistics)
Vital Statistics - 346
Electronic File
EFVS-271.1
Disinterment Consent Form (Vital Statistics)
Vital Statistics - 346
Electronic File
FVS-141
Application for Certified Copy of Birth or Death Certificates (Birth Certificate)
Vital Statistics - 71
Forms
E05-12577
Texas Child Fatality Review Team Post
Title V-Child Fatality Review - 691
Electronic File
Dental Health / Salud dental E08-12876
Dental Anticipatory Guidance
Oral Health - 597
Electronic File
EPSDT-10
Take Time for Teeth (Dental Poster) (16" x 20")
Texas Health Steps - 24
Electronic File
EF08-12882
Oral Evaluation and Fluoride Varnish in the Medical Home Visit Documentation
Oral Health - 695
Electronic File
EF08-12881
First Dental Home Visit Documentation
Oral Health - 695
Electronic File
EF08-12880
Caries Risk Assessment Tool
Oral Health - 695
Electronic File
E8-20
Take Time for Teeth Flipchart
Texas Health Steps - 24
Electronic File
E25-12581
Highlights: The Supply of General Dentists in Texas - 2006
Hlth Prof Resource Ctr 662
Electronic File
E10-15J
ABCs of Health - Tobacco
Adult Health - 231
Electronic File
E08-13373
First Dental Home Visits-Required Elements
Oral Health - 597
Electronic File
08-10203
Helpful Hints to Keep Your Child's Teeth Healthy Poster
Oral Health - 256
Posters
E08-13077
Fluoride Varnish Manual - Happy Smile, Happy Child
Oral Health - 714
Electronic File
E08-12610
Teacher's Guide of Dental Activities
Oral Health - 714
Electronic File
E08-0018
Oral Health School Nurse Manual (click on Education on web page)
Oral Health - 695
Electronic File
8-20
Take Time for Teeth Flipchart (Limit 10)
Oral Health - 597
Flip Charts
E08-13273
Seal in a Smile, Texas Style Sealant Manual
Oral Health - 830
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 20 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Depression / Depresion EB-106
Does My Child Have an Attention Disorder?
CMAP-Patient/Family Ed 655
Electronic File
EF105-12317
Symptom and Side Effects Monitoring Sheet- Depression
TIMA-Patient/Family Ed 586
Electronic File
EB-105
Most Children Who Are Depressed Won't Tell You They Feel Sad
CMAP-Patient/Family Ed 654
Electronic File
EB-104
Life Can Be Tough
CMAP-Patient/Family Ed 654
Electronic File
EB-103
Kris, Are You Sad? (coloring book)
CMAP-Patient/Family Ed 654
Electronic File
EB-102
Brain Function Sheet: Depression
TIMA-Patient/Family Ed 586
Electronic File
E105-12319
Medication Benefit Sheet: Depression
TIMA-Patient/Family Ed 586
Electronic File
B-103
Kris, Are You Sad? (Limit 1)
Warehouse
Coloring Books
B-102
Brain Function Sheet: Depression (Limit 1)
Warehouse
Fact Sheets
F105-12317
Symptom and Side Effects Monitoring Sheet- Depression
TIMA-Patient/Family Ed 585
Forms
Electronic File
Diabetes / Diabetes E45-11266
Exercise Algorithm - IFG/Type 2 Diabetes Prevention and Therapy
Texas Diabetes Council 197
E10-114
Diabetes Tool Kit
Adult Health - 231
Electronic File
E45-10778
Medical Nutrition Algorithm IFG/Type 2 Diabetes Prevention and Therapy
Texas Diabetes Council 197
Electronic File
E45-10777
Lipid Treatment Algorithm for Type 1 and Type 2 Diabetes Mellitus in Adults
Texas Diabetes Council 197
Electronic File
E45-10524
A Plan to Control Diabetes in Texas
Texas Diabetes Council 425
Electronic File
E45-10293
Diabetic Eye Disease Program Brochure
Texas Diabetes Council 438
Electronic File
E16-11164
Texas Risk Factor Report
Behavioral Risk Factor Surveillance System - 223
Electronic Newsletter/Magazine
E13-06-11468
Type 2 Diabetes, No. 25
Nutrition Services - 199
Electronic File
E13-06-11467
Type 1 Diabetes, No. 24
Nutrition Services - 199
Electronic File
E10-28
Living With Diabetes
Texas Diabetes Council 375
Electronic File
E45-11647
Insulin Algorithm for Type 2 Diabetes Mellitus in Children and Adults
Texas Diabetes Council 197
Electronic File
E10-24
Food for Life-Living Well With Diabetes
Texas Diabetes Council 375
Electronic File
E45-11004
Texas Diabetes Newsletter (also called The Cornerstone)
Texas Diabetes Council 768
Electronic Newsletter/Magazine
E06-10252
Gestational Diabetes, No. 12
Nutrition Services - 199
Electronic File
DEDP 6
Diabetic Eye Disease Program Request for Tracking Forms
Texas Diabetes Council 305
Forms
DEDP 4
Diabetic Eye Disease Program Agreement Between Eye Care Provider and Dept of State Heath Services
Texas Diabetes Council 305
Forms
DEDP 2
Diabetic Eye Disease Program Nominator Application
Texas Diabetes Council 305
Forms
DEDP 1
Diabetic Eye Disease Program Sample Patient Tracking Form
Texas Diabetes Council 305
Forms
Stock #4-25-lang Revised 10/25/2010
Page 21 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
BCD-DVDE
Controlling Diabetes One Day at a Time (Limit 5)
Warehouse
DVD
45-11004
Texas Diabetes Newsletter
Texas Diabetes Council 305
Newsletters
45-10523
If You Have Diabetes, A Flu Shot Could Save Your Life (poster)
Texas Diabetes Council 305
Posters
10-26
If You Are Diabetic, Please Remove Your Shoes & Socks (Limit 100)
Warehouse
Posters
E10-27
Could You Have Diabetes?
Texas Diabetes Council 375
Electronic File
E45-12000
Diabetic Foot Care Algorithm
Texas Diabetes Council 197
Electronic File
EF45-13284
Diabetes Mellitus Registry Pilot Program Consent Form
Texas Diabetes Council 831
Electronic File
EDEDP-6
Diabetic Eye Disease Program Request for Tracking Forms
Texas Diabetes Council 438
Electronic File
EDEDP-4
Diabetic Eye Disease Program Agreement Between Eye Care Provider and Texas Dept of Heath
Texas Diabetes Council 438
Electronic File
EDEDP-2
Diabetic Eye Disease Program Nominator Application
Texas Diabetes Council 438
Electronic File
EDEDP-1
Diabetic Eye Disease Program Sample Patient Tracking Form
Texas Diabetes Council 438
Electronic File
E45-12614
ICU Insulin Order - IV Insulin Infusion Protocol
Texas Diabetes Council 197
Electronic File
E45-12613
Recommendations for Treatment of Painful Peripheral Diabetic Neuropathy
Texas Diabetes Council 197
Electronic File
E45-12612
Diabetic Eye Disease Program Manual
Texas Diabetes Council 438
Electronic File
E45-12085
Diabetes Mellitus Minimum Practice Recommendations Flow Sheet
Texas Diabetes Council 197
Electronic File
E45-10960
Type 2 Diabetes in Children and Adolescents Statewide Action Plan
Texas Diabetes Council 425
Electronic File
E45-12063
IV Insulin Infusion Protocol for Critically-Ill Adult Patients in the ICU Setting
Texas Diabetes Council 197
Electronic File
E45-10961
Putting the Brakes on Diabetes: A Community Planning Guide to Improve Health and Nutrition for Texas
Texas Diabetes Council 425
Electronic File
E45-11942
Macrovascular Risk Reduction in Diabetes: Antiplatelet Therapy
Texas Diabetes Council 197
Electronic File
E45-11825
Prevention and Delay of Type 2 Diabetes Algorithm
Texas Diabetes Council 197
Electronic File
E45-11694
Weight Loss Algorithm for Overweight and Obese Adults
Texas Diabetes Council 197
Electronic File
E45-11653
Pediatric Diabetes Research in Texas
Texas Diabetes Council 425
Electronic File
E45-11649
Insulin Algorithm for Type 1 Diabetes Meliltus in Children and Adults
Texas Diabetes Council 197
Electronic File
E45-11267
Hypertension Algorithm for Diabetes Mellitus in Adults
Texas Diabetes Council 197
Electronic File
E45-11265
Glycemic Control Algorithm for Type 2 Diabetes Mellitus in Children and Adults
Texas Diabetes Council 197
Electronic File
F45-03729
Diabetic Eye Disease Tracking Form
Texas Diabetes Council 305
Forms
E45-12083
Weight Management Algorithm for Overweight Children and Adolescents
Texas Diabetes Council 197
Electronic File
Birth Defects Epi - 324
Electronic File
Disabilities & the Disabled / Discapacidades y Personas discapacitadas E58-10957R
Birth Defect Risk Factor Series: Pyloric Stenosis
Stock #4-25-lang Revised 10/25/2010
Page 22 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E58-10957V
Birth Defect Risk Factor Series: 47,XXX
Birth Defects Epi - 324
Electronic File
E58-10957T
Birth Defect Risk Factor Series: Triploidy
Birth Defects Epi - 324
Electronic File
E58-10957W
Birth Defect Risk Factor Series: 47,XYY
Birth Defects Epi - 324
Electronic File
E58-10957U
Birth Defect Risk Factor Series: Turner Syndrome
Birth Defects Epi - 324
Electronic File
E58-10957S
Birth Defect Risk Factor Series: Renal Agenesis
Birth Defects Epi - 324
Electronic File
E58-10957Q
Birth Defect Risk Factor Series: Intestinal Atresia/Stenosis
Birth Defects Epi - 324
Electronic File
E58-10957P
Birth Defect Risk Factor Series: Ear Defects
Birth Defects Epi - 324
Electronic File
E58-10957O
Birth Defect Risk Factor Series: Conotruncal Heart Defect
Birth Defects Epi - 324
Electronic File
E58-10957N
Birth Defect Risk Factor Series: Atrial Septal Defect
Birth Defects Epi - 324
Electronic File
E58-10957M
Birth Defect Risk Factor Series: Anal Atresia
Birth Defects Epi - 324
Electronic File
E58-10957L
Birth Defect Risk Factor Series: Trisomy 18
Birth Defects Epi - 324
Electronic File
E58-10957K
Birth Defect Risk Factor Series: Trisomy 13
Birth Defects Epi - 324
Electronic File
E58-10957J
Birth Defect Risk Factor Series: Oral Clefts
Birth Defects Epi - 324
Electronic File
E58-10957I
Birth Defect Risk Factor Series: Omphalocele
Birth Defects Epi - 324
Electronic File
E58-10827
Birth Defects Glossary
Birth Defects Epi - 169
Electronic File
E58-10957H
Birth Defect Risk Factor Series: NTDs
Birth Defects Epi - 324
Electronic File
E58-11040
Birth Defects Audiovisual Catalog
Audiovisual Library - 196
Electronic File
58-10955
Texas Birth Defects Monitor: A Semiannual Data and Research Update
Birth Defects Epi - 110
Newsletters
05-10004
The CAHOOT Newsletter
Newborn Screening - 67
Newsletters
E05-10004
The CAHOOT Newsletter
Newborn Screening - 282
Electronic Newsletter/Magazine
E1-194
Specimen Collection Guide
Newborn Screening - 68
Electronic File
E58-10955
Texas Birth Defects Monitor: A Semiannual Data and Research Update
Birth Defects Epi - 169
Electronic Newsletter/Magazine
E58-10957B
Birth Defect Risk Factor Series: Craniosynostosis
Birth Defects Epi - 324
Electronic File
E58-10957C
Birth Defect Risk Factor Series: Diaphragmatic Hernia
Birth Defects Epi - 324
Electronic File
E58-10957D
Birth Defect Risk Factor Series: Down Syndrome
Birth Defects Epi - 324
Electronic File
E58-10957E
Birth Defect Risk Factor Series: Gastroschisis
Birth Defects Epi - 324
Electronic File
E58-10957F
Birth Defect Risk Factor Series: Holoprosenchephaly
Birth Defects Epi - 324
Electronic File
E58-10957G
Birth Defect Risk Factor Series: Hydrocephaly
Birth Defects Epi - 324
Electronic File
E07-12153
What is a Medical Home? (Medical Home Brochure)
Children w/Special Health Care Needs - 512
Electronic File
Disease and Injury Prevention / Prevencion de enfermedades y lesiones 16-11164
Texas Risk Factor Report
Behavioral Risk Factor Surveillance System - 222
Newsletters
E10-15B
ABCs of Health - Breast Examination and Mammogram/Pap Test
Adult Health - 231
Electronic File
04-11373
Chronic Disease in Texas Newsletter
Tobacco Prevention - 272
Newsletters
E04-11373
Chronic Disease in Texas Newsletter
Adult Health - 231
Electronic Newsletter/Magazine
E44-10831
1998-99 Biennial Report of the Osteoporosis Advisory Committee
Osteoporosis - 225
Electronic File
E10-15C
ABCs of Health - Cholesterol
Adult Health - 231
Electronic File
Essential Epidemiology and Laboratory Components of a State Foodborne Disease Prev & Control Program
Infectious Disease - 431
Electronic File
E59-11370
Stock #4-25-lang Revised 10/25/2010
Page 23 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E33-11383
Health Observances Calendar
Web Technology Services - 275
Electronic File
E25-11033
Texas Health Facts
Center for Health Statistics - 191
Electronic File
E16-11164
Texas Risk Factor Report
Behavioral Risk Factor Surveillance System - 223
Electronic Newsletter/Magazine
E10-15K
ABCs of Health - Stress
Adult Health - 231
Electronic File
E10-15D
ABCs of Health - Cancer
Adult Health - 231
Electronic File
E10-15F
ABCs of Health - High Blood Pressure
Adult Health - 231
Electronic File
E19-11724
Defend Yourself Against West Nile Virus
Infectious Disease - 381
Electronic File
E10-15J
ABCs of Health - Tobacco
Adult Health - 231
Electronic File
E59-11312
Home vs. Hospital Care Precautions for Antibiotic Resistant Bacteria
Infectious Disease - 400
Electronic File
Drug Abuse / Abuso de drogas TCADA-32
An Ethnographic Study of Mexican American Inhalant Abusers in San Antonio, Texas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-9
Why People Don't Use Illicit Drugs
Mental Hlth/Sub Abuse 487
Electronic File
TCADA-34
Comparison of Patterns of Illicit Drug Use in Australia and the United States
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-35
Crack Cocaine as a Major Risk of HIV Transmission in a Crack House Population
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-36
Understanding Inhalant Users: An Overview for Parents, Educators, and Clinicians
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-37
Methadone in Texas: Analysis of Treatment, Arrest, and Overdose Data
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-38
An Ethnographic Study of Heroin Abuse by Mexican Americans in San Antonio, Texas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-40
Patterns of Volatile Substance Abuse Among the Kickapoo People in Eagle Pass, Texas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-43
Texas Survey of Postpartum Women and Drug-Exposed Infants
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-47
Current Trends in Substance Use in Texas
Mental Hlth/Sub Abuse 490
Electronic File
TCADA-51
Indicators of Alcohol and Drug Abuse In Texas
Mental Hlth/Sub Abuse 491
Electronic File
TCADA-56
Substance Abuse Pilot Treatment Program for Criminal Offenders: Summary Report
Mental Hlth/Sub Abuse496
Electronic File
TCADA-31
An Ethnographic Comparison of the Mexican American Drug Culture in El Paso, Texas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-58
A Dictionary of Slang Drug Terms, Their Generic and Trade Names, and Pharmacological Effects and Use
Mental Hlth/Sub Abuse 497
Electronic File
TCADA-39
Heroin Abuse Trends in Texas and Results on the 1994 Survey of Methadone Programs
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-26
GHB Withdrawal Syndrome
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-13
Being Drug Free: Resillency Factors in Texas Youth
Mental Hlth/Sub Abuse 485
Electronic File
TCADA-57
Comparative Pharmacological Profiles of Abused Drugs
Mental Hlth/Sub Abuse 497
Electronic File
TCADA-27
Sexually Transmitted Diseases and Hepatitis B and C in Three Drug Abuse Clinics in Texas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-29
Heroin Addicts in Texas: The Nature and Size of a Hidden Population
Mental Hlth/Sub Abuse 488
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 24 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
TCADA-28
Leaning on Syrup: The Misuse of Opioid Cough Syrup in Houston
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-3
Economic Costs of Alcohol and Drug Abuse in Texas
Mental Hlth/Sub Abuse 493
Electronic File
TCADA-41
The History of Drug Abuse in Texas, Selected Metropolitan Areas
Mental Hlth/Sub Abuse 488
Electronic File
Drugs / Drogas y farmacos Rohypnol-1
Teens and Rohypnol poster
HSR 9/10 - 287
Posters
EF23-10856
Drug Distributor (Manufacturer) License Application
Drugs & Food Safety Licensing - 89
Electronic File
Rohypnol-2
It is Against the Law (Rohypnol)
HSR 9/10 - 287
Posters
EF23-10618
Tattoo Studio License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10611
Drug Distributor License Verification Affidavit
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10854
Drug Distributor License Application
Drugs & Food Safety Licensing - 89
Electronic File
TCADA-58
A Dictionary of Slang Drug Terms, Their Generic and Trade Names, and Pharmacological Effects and Use
Mental Hlth/Sub Abuse 497
Electronic File
Ears & Hearing Disorders / Oidos y Trastornos de audicion E76-11489
Texas Occupations Code (Speech, Language Pathology, Audiology)
State Bd of Examiners for Speech & Audiology - 203
Electronic File
F69-10733
State Comm of Exam in Fitting & Disp of Hearing InstrumentsApplication Form
St. Comm. Examrs. In Fit & Disp. Hear Instr - 126
Forms
F05-06832
Audiometer Loan Application
Audiometric Lab - 74
Forms
ENBH-PB1
Texas Early Hearing Detection and Intervention Program, Information Professionals Need to Know
Texas Health Steps - 24
Electronic File
EM-77
Hearing Aid Evaluation Report
Audiology - 440
Electronic File
EM-79
Receipt for Hearing Aid
Audiology - 440
Electronic File
EM-71
Risk Criteria Checklist
Audiology - 440
Electronic File
EM-40
Sweep-Check Screening Form
Vision, Hearing and Spinal Screening - 65
Electronic File
E76-11560
Position Statement Relating to Hearing Aid Fitting for Adults
State Bd of Examiners Speech & Audiology - 435
Electronic File
E76-11559
Position Statement Relating to Newborn Hearing Screening
State Bd of Examiners Speech & Audiology - 435
Electronic File
E76-11555
Position Statement Relating to Workload and Caseload Size in the Public Schools
State Bd of Examiners Speech & Audiology - 435
Electronic File
E76-11488
Board Rules (Speech, Language Pathology, Audiology)
State Bd of Examiners for Speech & Audiology - 203
Electronic File
E1-84
Hearing Quiz
PACT-Health Steps - 778
Electronic File
E05-12258
1-3-6 Month Practioner's Guide
PACT-Health Steps - 554
Electronic File
E05-06069
Vision and Hearing Requirements and Procedures
Vision, Hearing and Spinal Screening - 65
Electronic File
76-10794
St Bd Exam for Speech-Lang Pathology and Audiology Newsletter
State Bd of Examiners Speech & Audiology - 129
Newsletters
05-12258
1-3-6 Month Practioner's Guide
PACT-Health Steps - 782
Electronic File
F76-10784
Audiology Course Work and Clinical Experience Form
State Bd of Examiners Speech & Audiology - 129
Forms
E76-11556
Position Statement Relating to Continuing Education Credit for Coursework & AMA
State Bd of Examiners Speech & Audiology - 435
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 25 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F76-10797
St Bd Exam for Speech-Lang Pathology and Audiology-Superv Resp Statement for Assts
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10787
Speech-Language Pathology Course Work and Clinical Experience Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10798
Supervision Log - Speech-Language Pathology and Audiology
State Bd of Examiners Speech & Audiology - 129
Forms
EM-76
Report of Otological Examination
Audiology - 440
Electronic File
F76-10796
St Bd Exam for Speech-Lang Pathology and Audiology - Report of Completed Internship Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10795
St Bd Exam for Speech-Lang Pathology and Audiology-Rec of Cont Educ Hrs Earned Used
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10792
St Bd Exam for Speech-Lang Pathology and Audiology-Fitting & Disp of Hearing Instr Reg
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10790
St Bd Exam for Speech-Lang Pathology and Audiology-Clinical Observ & Exp for Assts. Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10789
St Bd Exam for Speech-Lang Pathology and Audiology - Application Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10793
St Bd Exam for Speech-Lang Pathology and Audiology - Intern Plan & Agreement of Sup Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10788
St Bd Exam for Speech-Lang Pathology and Audiology-Alt Meth for Assistant to Obtain Clinical Observ
State Bd of Examiners Speech & Audiology - 129
Forms
M-71
Risk Criteria Checklist
Warehouse
Forms
Emergency Preparedness / Preparacion ante emergencias E19-12246
What You Need to Know about Returning to a Flooded Building
External Relations Communications - 545
Electronic File
E19-12247
What You Need to Know about Heat
External Relations Communications - 545
Electronic File
E19-12342
Colds, Flu and Anthrax Comparison
External Relations Communications - 588
Electronic File
E19-12343
Outlook on Bioterrorism: A Survey of Texans
External Relations Communications - 589
Electronic File
E19-12244
What You Need to Know about Floods
External Relations Communications - 545
Electronic File
E19-13242
What you need to know about Vibrio
Communications - 827
Electronic File
E19-12245
What You Need to Know about Flooding and Diarrheal Illness
External Relations Communications - 545
Electronic File
E19-13243
What you need to know about Carbon Monoxide and Generators
Communications - 826
Electronic File
E19-13244
What you need to know about Hurricane Preparedness and Response
Communications - 827
Electronic File
E19-13245
What you need to know about Mold
Communications - 826
Electronic File
E19-13246
What you need to know about Mosquitoes
Communications - 827
Electronic File
E19-13238
What You Need to Know about Family Preparedness
Communications - 823
Electronic File
B19-13247
What you need to know about Tornadoes
Communications - 826
Electronic File
6-82P
Texas Poison Center Network and Terrorism (poster)
Warehouse
Posters
Emergency Services / Servicios de emergencia EF01-11421
Department of State Health Services Standard Out-of-Hospital Do Not Resuscitate Order (DNR)
EMS - 292
Electronic File
EF01-13069
EMS Provider License-Personnel
EMS - 792
Electronic File
EF01-13068
EMS Provider License Administrator Information
EMS - 792
Electronic File
EF01-13067
EMS Provider License Application
EMS - 792
Electronic File
EF01-13066
EMS Provider License Declaration Form
EMS - 792
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 26 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF01-11816
Emergency Care Attendant Training Request
EMS- 411
Electronic File
EF01-13070
EMS Provider Vehicle Form
EMS - 792
Electronic File
F01-13069
EMS Provider License-Personnel
EMS - 791
Forms
E-EMS-014
When Minutes Count - A Citizen's Guide to Medical Emergencies
EMS - 532
Electronic File
EF01-13065
EMS Provider License Certificate / Vehicle Authorization Replacement Request
EMS - 792
Electronic File
EF01-13071
EMS Provider-Medical Director Information Form
EMS - 792
Electronic File
EF01-13072
EMS Provider License Notification/Changes
EMS - 792
Electronic File
F01-13065
EMS Provider License Certificate / Vehicle Authorization Replacement Request
EMS - 791
Forms
F01-13066
EMS Provider License Declaration Form
EMS - 791
Forms
F01-13068
EMS Provider License Administrator Information
EMS - 791
Forms
E-EMS-012
EMS: System to Save a Life
EMS - 532
Electronic File
F01-13070
EMS Provider Vehicle Form
EMS - 791
Forms
F01-13071
EMS Provider-Medical Director Information Form
EMS - 791
Forms
F01-13072
EMS Provider License Notification/Changes
EMS - 791
Forms
TEX-EMS
Texas EMS Magazine
EMS - 532
Electronic Newsletter/Magazine
F01-13067
EMS Provider License Application
EMS - 791
Forms
E09-MT04LV
Mortality in Trauma Service Area by Cause: RACs L-V 2004
Epidemiology/Injury Surveillance - 516
Electronic File
56-12176
Preparedness and Response Newsletter
HSR 9/10 - 524
Newsletters
E01-13438
EMS and Trauma Systems Overview
EMS - 878
Electronic File
E09-12166
Overview of Injury in Texas and the Role of the EMS/Trauma Registry
Epidemiology/Injury Surveillance - 516
Electronic File
E09-13474
Surveillance Report for Trauma Service Area Q, EMS/Trauma Registry 2008
Prevention & Preparedness - 829
Electronic File
E-EMS-008
Questions That Citizens Ask About EMS
EMS - 532
Electronic File
E09-MT03LV
Mortality in Trauma Service Area by Cause: RACs L-V 2003
Epidemiology/Injury Surveillance - 516
Electronic File
4-61
Ready Teddy Talks About Emergency Medical Services & Injury Prevention (Limit 500)
Warehouse
Coloring Books
E09-MT04AK
Mortality in Trauma Service Area by Cause: RACs A-K 2004
Epidemiology/Injury Surveillance - 516
Electronic File
E09-MT03AK
Mortality in Trauma Service Area by Cause: RACs A-K 2003
Epidemiology/Injury Surveillance - 516
Electronic File
E1-26
What Parents Need to Know About Lead Poisoning
Childhood Lead Poisoning - 386
Electronic File
E19-11457
Communicable Disease Control Measures in Texas: A Guide for Hlth Authorities in Public Hlth Emerg
Regional & Local Svs - 321 Electronic File
E19-12244
What You Need to Know about Floods
External Relations Communications - 545
Electronic File
E4-23
Emergency Medical Services (EMS) Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E56-12176
Preparedness and Response Newsletter
HSR 9/10 - 593
Electronic Newsletter/Magazine
Emotions / Emociones E111-13202
Helping the Elderly Recover from the Emotional Aftermath of a Disaster
PRIDE Crisis Counseling 813
Electronic File
E111-13203
Helping Children Recover from the Emotional Aftermath of a Disaster
PRIDE Crisis Counseling 813
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 27 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E111-13200
No One Who Sees a Disaster is Untouched by it
PRIDE Crisis Counseling 813
Electronic File
B-103
Kris, Are You Sad? (Limit 1)
Warehouse
Coloring Books
EB-105
Most Children Who Are Depressed Won't Tell You They Feel Sad
CMAP-Patient/Family Ed 654
Electronic File
EB-103
Kris, Are You Sad? (coloring book)
CMAP-Patient/Family Ed 654
Electronic File
EB-104
Life Can Be Tough
CMAP-Patient/Family Ed 654
Electronic File
E111-13201
Recovering from the Emotional Aftermath of a Disaster
PRIDE Crisis Counseling 813
Electronic File
Environmental Health / Salud ambiental Presidio
Health and Environmental Survey, City of Presidio, December 1995
HSR 9/10 - 584
Electronic File
F18-12283
AHERA Compliance Inspection Checklist
Asbestos - 607
Forms
H-68
Advisory Guidelines
Warehouse
Forms
F18-12144
Mold Remediation Notification Form
PSQA-Envir Hazards - 405
Forms
F18-12164
Mold - Notice of Inspection
PSQA-Envir Hazards - 405
Forms
F49-11634
Electronic Filing Cover Sheet for the Texas Tier Two Report
Policy, Standards, & Quality Assurance Unit 100
Forms
F18-12249
Company Name Change (Environmental & Sanitation LicensingMold)
PSQA-Envir Hazards - 405
Forms
F49-11630
Sample Training Roster (Model Employee Training Roster-Texas Hazard Communication Act)
Policy, Standards, & Quality Assurance Unit 100
Forms
F49-11629
Tier Two Paperwork Reduction Form (PRF)
Policy, Standards, & Quality Assurance Unit 100
Forms
F18-12082
Business Information Form (Asbestos Program)
Asbestos - 148
Forms
EF18-11676
Asbestos Application/Renewal Asbestos Inspector
Asbestos Program - 361
Electronic File
EF18-12283
AHERA Compliance Inspection Checklist
PSQA-Asbestos - 573
Electronic File
EF18-11673
Asbestos License Application/Renewal Asbestos Worker
Asbestos Program - 361
Electronic File
E09-13360
Evaluating Chromium Exposure: Information for Healthcare Providers
Hlth Assessment/Toxicology 754
Electronic File
E09-12821
Pesticides in Your Path
Pesticide Exposure Surv (PEST) - 452
Electronic File
E09-11644
Texas Hazardous Substances Emergency Events Surveillance (HSEES) System Dec 2001 Security Survey of
Environ Epidemiology & Toxicology - 357
Electronic File
EF18-11674
Asbestos License Application/Renewal Abatement Supervisor
Asbestos Program - 361
Electronic File
EF18-11675
Asbestos Consultant Agency License Application
Asbestos Program - 361
Electronic File
E09-11643
Texas Hazardous Substances Emergency Events Surveillance (HSEES) 1993-2000 Rpt on Trucking Services
Environ Epidemiology & Toxicology - 357
Electronic File
E09-04628
Firing Ranges Shooter's Guide
Epidemiology - 663
Electronic File
49-11745
Hazardous Substances Act Registration Fact Sheet
Policy, Standards, & Quality Assurance Unit 100
Fact Sheets
4644
Firing Ranges Employer's Guide
Epidemiology - 663
Electronic File
232-1
Notice to Employees - Dentists only - Texas Regulations for Control of Radiation
Radiation Control - 326
Electronic File
EF18-11672
Asbestos Contractor License Application
Asbestos Program - 361
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 28 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
18-10469
Attention Poster (asbestos)
PSQA-Envir Hazards - 405
Posters
E18-10947
Texas Asbestos Health Protection Rules
PSQA-Envir Hazards - 163
Electronic File
EF18-11678
Asbestos Management Planner Agency License Application
Asbestos Program - 361
Electronic File
EF18-11680
Asbestos License Application/Renewal Project Manager
Asbestos Program - 361
Electronic File
EF18-11681
Asbestos Application/Renewal Air Monitor Technician
Asbestos Program - 361
Electronic File
EF18-11682
Asbestos Laboratory License Application
Asbestos Program - 361
Electronic File
EF18-11683
Asbestos Transporter License Application
Asbestos Program - 361
Electronic File
EF18-11691
Application for Asbestos Agency Duplicate License/Registration
Asbestos Program - 361
Electronic File
EF18-11692
Application for Company Name Change (Asbestos Program)
Asbestos Program - 361
Electronic File
EF18-12048
Mold Licensing Program Complaint Form
PSQA-Envir Hazards - 365
Electronic File
EF18-12058
Mold Training Instructor Reference Form
PSQA-Envir Hazards - 365
Electronic File
EF18-12082
Business Information Form (Asbestos Program)
Asbestos Program - 361
Electronic File
EF18-12144
Mold Remediation Notification Form
PSQA-Envir Hazards - 365
Electronic File
EF18-12249
Company Name Change (Environmental & Sanitation LicensingMold)
PSQA-Envir Hazards - 365
Electronic File
203-1
Notice to Employees - Texas Regulations for Control of Radiation
Radiation Control - 326
Electronic File
E22-11395
Final Report of the Texas Indoor Radon Survey
Radiation Control - 464
Electronic File
EF18-11667
Asbestos Application Individual Name Change
Asbestos Program - 361
Electronic File
EF18-11665
Asbestos License New/Renewal Training Provider
Asbestos Program - 361
Electronic File
18-10948
Asbestos Programs Branch Update (Asbestos newsletter)
Asbestos - 148
Newsletters
F18-12058
Mold Training Instructor Reference Form
Indoor Air Quality - 553
Forms
EF18-11668
Asbestos Application Individual Duplicate
Asbestos Program - 361
Electronic File
EF18-11664
State Accreditation Examination Registration Form (Asbestos Program)
Asbestos Program - 361
Electronic File
EF09-11927
Human Pesticide Exposure Report Form
Pesticide Exposure Surv (PEST) - 452
Electronic File
EAPB#5
Demolition/Renovation Notification Form
Envir Hlth-PSQA - 606
Electronic File
EAPB#3
Homeowners' Guide to Safe Removal of Asbestos Containing Materials
PSQA-Envir Hazards - 162
Electronic File
E58-10957D
Birth Defect Risk Factor Series: Down Syndrome
Birth Defects Epi - 324
Electronic File
E56-11815
Assessment of Parasitic Disease in Children in Five Communities in the Border Region-Far West Texas
HSR 9/10 - 584
Electronic File
E56-11472
Brewster County Health and Environmental Survey, May 2002
HSR 9/10 - 584
Electronic File
E16-11829
Impact of Clean Indoor Air Ordinances on Restaurant Revenues in 4 Texas Cities
Substance Abuse Services - Electronic File Tobacco - 234
E49-11726
Inspection Guide Brochure
Envir Hlth-PSQA - 55
Electronic File
EF18-11679
Asbestos Application/Renewal Individual Management Planner
Asbestos Program - 361
Electronic File
E22-10861
Incident Summary
Radiation Control - 177
Electronic File
E2-15
Texas Mold Assessment and Remediation Rules
PSQA-Envir Hazards - 365
Electronic File
E2-14
Protecting Your Home From Mold
Indoor Air Quality - 345
Electronic File
E2-10
Texas Voluntary Indoor Air Quality Guidelines for Government Buildings
Indoor Air Quality - 8
Electronic File
E19-13245
What you need to know about Mold
Communications - 826
Electronic File
EF18-11669
Physician's Written Statement (Asbestos Program)
Asbestos Program - 361
Electronic File
E18-12049
Consumer Mold Information Sheet
PSQA-Envir Hazards - 365
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 29 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E18-11310
Asbestos Regulatory Clarifications (ARCs)
PSQA-Envir Hazards - 632
Electronic File
EF18-11670
Asbestos Operations & Maintenance Contractor (Restricted) License Application
Asbestos Program - 361
Electronic File
E18-10993
General Asbestos Frequently Asked Questions
PSQA-Envir Hazards - 163
Electronic File
E18-10948
Asbestos Programs Branch Update (Asbestos newsletter)
Envir Hlth-PSQA - 606
Electronic Newsletter/Magazine
EF18-11671
Asbestos License Application/Renewal Operations & Maintenance Supervisor
Asbestos Program - 361
Electronic File
E49-11745
Hazardous Substances Act Registration Fact Sheet
Consumer Prod Safety 423
Electronic File
F09-11927
Human Pesticide Exposure Report Form
Pesticide Exposure Surv (PEST)- 702
Forms
F18-11667
Asbestos Application Individual Name Change
Asbestos - 148
Forms
EF49-11630
Sample Training Roster (Model Employee Training Roster-Texas Hazard Communication Act)
Envir Hlth-PSQA - 55
Electronic File
F18-11672
Asbestos Contractor License Application
Asbestos - 148
Forms
F18-11671
Asbestos License Application/Renewal Operations & Maintenance Supervisor
Asbestos - 148
Forms
EF49-11632
Workplace Chemical List as required by Texas Hazard Communication Act
Envir Hlth-PSQA - 55
Electronic File
EF49-11628
Tier Two Chemical Description Sheet
Tier Two - 349
Electronic File
EF49-11634
Electronic Filing Cover Sheet for the Texas Tier Two Report
Tier Two - 349
Electronic File
F18-11673
Asbestos License Application/Renewal Asbestos Worker
Asbestos - 148
Forms
EF18-11677
Asbestos Application/Renewal Individual Asbestos Consultant
Asbestos Program - 361
Electronic File
F18-11429
Site Inspection Checklist/NESHAP & TAHPA
Asbestos - 607
Forms
F18-11664
State Accreditation Examination Registration Form (Asbestos Program)
Asbestos - 148
Forms
F18-11669
Physician's Written Statement (Asbestos Program)
Asbestos - 148
Forms
F18-11665
Asbestos License New/Renewal Training Provider
Asbestos - 148
Forms
F18-11668
Asbestos Application Individual Duplicate
Asbestos - 148
Forms
F18-11670
Asbestos Operations & Maintenance Contractor (Restricted) License Application
Asbestos - 148
Forms
EF49-11523
Hazardous Substance Registration Application Form
Reg Licensing - Hazardous Prod- 773
Electronic File
F18-11691
Application for Asbestos Agency Duplicate License/Registration
Asbestos - 148
Forms
F18-11682
Asbestos Laboratory License Application
Asbestos - 148
Forms
F18-11681
Asbestos Application/Renewal Air Monitor Technician
Asbestos - 148
Forms
EF49-11290
Application for Volatile Chemical Sales Permit
Abusive Volatile Chemicals Program - 192
Electronic File
EF49-11629
Tier Two Paperwork Reduction Form (PRF)
Tier Two - 349
Electronic File
F18-11692
Application for Company Name Change (Asbestos Program)
Asbestos - 148
Forms
F18-11683
Asbestos Transporter License Application
Asbestos - 148
Forms
F18-11679
Asbestos Application/Renewal Individual Management Planner
Asbestos - 148
Forms
F18-11680
Asbestos License Application/Renewal Project Manager
Asbestos - 148
Forms
EF49-11627
Tier Two Cover Sheet
Tier Two - 349
Electronic File
F18-11678
Asbestos Management Planner Agency License Application
Asbestos - 148
Forms
F18-11677
Asbestos Application/Renewal Individual Asbestos Consultant
Asbestos - 148
Forms
F18-11676
Asbestos Application/Renewal Asbestos Inspector
Asbestos - 148
Forms
Stock #4-25-lang Revised 10/25/2010
Page 30 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F18-11675
Asbestos Consultant Agency License Application
Asbestos - 148
F18-12048
Mold Licensing Program Complaint Form
Indoor Air Quality - 553
Forms
Asbestos License Application/Renewal Abatement Supervisor
Asbestos - 148
Forms
F18-11674
Forms
Epilepsy / Epilepsia E3-1
Epilepsy and Driving
Epilepsy Services - 427
Electronic File
E41-13123
Policy and Procedures Manual for Epilepsy Services
Epilepsy Services - 799
Electronic File
E41-11440
Texas Department of State Health Services Epilepsy Program Rules
Epilepsy Services - 427
Electronic File
Eyes & Vision Disorders / Ojos y Trastornos visuales DEDP 1
Diabetic Eye Disease Program Sample Patient Tracking Form
Texas Diabetes Council 305
Forms
EF61-10684
Application for Contact Lens Disp Permit - Individual or Sole Proprietor
Contact Lens Dispensing Permit Program - 164
Electronic File
F67-10722
Opticians Registry - Application for Optician Registration
Optician's Registry Program - 133
Forms
F61-10684
Application for Contact Lens Disp Permit - Individual or Sole Proprietor
Contact Lens Dispensing Permit Program - 131
Forms
F61-10683
Application for Contact Lens Disp Permit-Corp or Other Business Entity
Contact Lens Dispensing Permit Program - 131
Forms
F45-03729
Diabetic Eye Disease Tracking Form
Texas Diabetes Council 305
Forms
F67-12090
Statement of Continuing Education Form for Opticians
Optician's Registry Program - 133
Forms
EF67-10722
Opticians Registry - Application for Optician Registration
Optician's Registry Program - 502
Electronic File
EF61-10683
Application for Contact Lens Dispensing Permit - Corporation or Other Business Entity
Contact Lens Dispensing Permit Program - 164
Electronic File
EDEDP-6
Diabetic Eye Disease Program Request for Tracking Forms
Texas Diabetes Council 438
Electronic File
EDEDP-4
Diabetic Eye Disease Program Agreement Between Eye Care Provider and Texas Dept of Heath
Texas Diabetes Council 438
Electronic File
EDEDP-2
Diabetic Eye Disease Program Nominator Application
Texas Diabetes Council 438
Electronic File
E45-12612
Diabetic Eye Disease Program Manual
Texas Diabetes Council 438
Electronic File
E45-10293
Diabetic Eye Disease Program Brochure
Texas Diabetes Council 438
Electronic File
DEDP 2
Diabetic Eye Disease Program Nominator Application
Texas Diabetes Council 305
Forms
DEDP 4
Diabetic Eye Disease Program Agreement Between Eye Care Provider and Dept of State Heath Services
Texas Diabetes Council 305
Forms
E1-94
Vision Pamphlet
Vision, Hearing and Spinal Screening - 372
Electronic File
E05-06069
Vision and Hearing Requirements and Procedures
Vision, Hearing and Spinal Screening - 65
Electronic File
DEDP 6
Diabetic Eye Disease Program Request for Tracking Forms
Texas Diabetes Council 305
Forms
EF67-12090
Statement of Continuing Education Form for Opticians
Optician's Registry Program - 502
Electronic File
EDEDP-1
Diabetic Eye Disease Program Sample Patient Tracking Form
Texas Diabetes Council 438
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 31 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Family Planning / Planificacion familiar EWHR-IN
Women's Health Record Instructions
Perinatal/Maternal/Child 446
Electronic File
E13-6
Contraception and Breastfeeding, No. 18
Nutrition Services - 199
Electronic File
EWHR-1
Education/Counseling Record
Perinatal/Maternal/Child 446
Electronic File
EWHR-6
Provider Signature Sheet
Perinatal/Maternal/Child 446
Electronic File
E13-101
Family Planning and Breastfeeding
Nutrition Services - 809
Electronic File
EWHR-2
Routine Supply Visit
Perinatal/Maternal/Child 446
Electronic File
13-6
Contraception and Breastfeeding, No. 18 (Restricted to WIC Local Agencies)
Fact Sheets
First Aid / Primeros auxilios E19-12247
What You Need to Know about Heat
External Relations Communications - 545
Electronic File
E4-23
Emergency Medical Services (EMS) Audiovisual Catalog
Audiovisual Library - 196
Electronic File
4-61
Ready Teddy Talks About Emergency Medical Services & Injury Prevention (Limit 500)
Warehouse
Coloring Books
Food Safety & Hygiene / Seguridad alimenticia e Higiene EF23-12994
Certified Food Manager (CFM) Test Site - Initial Renewal
Drugs & Food Safety Licensing - 89
Electronic File
G-21RR
Grade "A" Raw for Retail Dairy
Milk Group - 746
Forms
EF23-12993
Certified Food Manager (CFM) Recertification - Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12996
Certified Food Manager (CFM) Examination Booklet Order Program Sites
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12997
Certified Food Manager (CFM) Examination Booklet Order - Test Sites
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12992
Certified Food Manager (CFM) Recertification - Initial, Renewal
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12998
Certified Food Manager (CFM) Food Handler Program - Initial, Renewal
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13281
Model Form 1-A Conditional Employee and Food Employee Interview
Food Establishments - 811
Electronic File
EF23-12995
Certified Food Manager (CFM) Test Site - Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF59-11343
Botulism--Foodborne Reporting Form
Infectious Disease - 185
Electronic File
EF59-11344
Botulism--Infant Reporting Form
Infectious Disease - 185
Electronic File
EF59-11345
Escherichia coli 0157:H7 and Hemolytic Uremic Syndrome Reporting Form
Infectious Disease - 185
Electronic File
EF59-11346
Escherichia coli 0157:H7 Food History Listing Form
Infectious Disease - 185
Electronic File
EF59-11347
Investigation of a Foodborne Outbreak Reporting Form
Infectious Disease - 185
Electronic File
E-Lister
What you should know about: Listeriosis (& listeriosis infection during pregnancy)
Infectious Disease - 183
Electronic File
G-21Path
Grade "A" Raw for Retail Dairy Pathogen Testing
Milk Group - 746
Forms
HYPGEN
Hypothesis Generating Questionnaire for Gastroenteritis Complaints
Infectious Disease - 185
Electronic File
E59-11316
Escherichia coli 0157:H7
Infectious Disease - 183
Electronic File
EF23-12991
Certified Food Manager (CFM) Certification - Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 32 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F47-10177
Condensed and Dry Milk and Whey
Milk Group - 31
Forms
E23-12906
Preventing Contamination from Hands
Food Establishment - 748
Electronic File
CDC5279
(CDC 52.79) Cholera & Other Vibrio Illnesses (Vibriosis Surveillance Form)
Infectious Disease - 185
Electronic File
E19-13242
What you need to know about Vibrio
Communications - 827
Electronic File
E13-11896
Hepatitis E Fact Sheet
HIV/STD - 449
Electronic File
E23-13196
FEGRC - No. 10: Demonstration of Knowledge
Food Establishments - 811
Electronic File
E23-10178
Safe Foods Save Lives
Infectious Disease - 630
Electronic File
E06-10105
Fact Sheet No. 1: A Quick Consumer Guide to Safe Food Handling
Nutrition Services - 199
Electronic File
E23-12785
Employees Must Wash Hands Before Returning to Work (handwash poster)
Food Establishments - 713
Electronic File
E23-13190
FEGRC - No. 4: Storage of Sanitizing Solution Buckets
Food Establishments - 811
Electronic File
E23-12786
Recommended Safe Food Temperatures
Food Establishments - 713
Electronic File
E19-12067
Botulism and Bioterrorism
External Relations Communications - 588
Electronic File
E23-13195
FEGRC - No. 9: Selling Yard Eggs at a Farmers Market
Food Establishments - 811
Electronic File
E23-12787
Double Handwash (poster)
Food Establishments - 713
Electronic File
E06-10106
Meat and Poultry Guidelines, No. 2
Nutrition Services - 199
Electronic File
E23-13194
FEGRC - No. 8: Restriction of a Food Employee with Lesions
Food Establishments - 811
Electronic File
E23-13197
FEGRC - No. 11: Competency of Inspectors
Food Establishments - 811
Electronic File
E23-12973
Mobile Food Vendor Checklist
Food Licensing -146
Electronic File
E23-13193
FEGRC - No. 7: Wooden Skewers as Single-Service Articles
Food Establishments - 811
Electronic File
E1-1
Texas Food Establishment Rules
Food Establishments - 713
Electronic File
E23-13187
FEGRC - No. 1: Hot Water at Vegetable/Prep Sinks
Food Establishments - 811
Electronic File
E13-06-12010
Food Safety During Pregnancy
Nutrition Services - 199
Electronic File
E23-13192
FEGRC - No. 6: Retail Requirements for Individual Quick Frozen (IQF) Oysters
Food Establishments - 811
Electronic File
E13-11892
Hepatitis A Fact Sheet
HIV/STD - 449
Electronic File
E23-13191
FEGRC - No. 5: Food Employee Infected with Hepatitis C Virus
Food Establishments - 811
Electronic File
EF23-12990
Certified Food Manager (CFM) Certification - Initial, Renewal, or Change of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
E23-13188
FEGRC - No. 2: Mobile Shrimp Vendors
Food Establishments - 811
Electronic File
E59-11328
Shigellosis
Infectious Disease - 183
Electronic File
E23-13189
FEGRC - No. 3: Growing "Wheat Grass" to add to Beverages
Food Establishments - 811
Electronic File
E06-10107
Handling Eggs Safely at Home, No. 3
Nutrition Services - 199
Electronic File
E59-11327
Salmonellosis
Infectious Disease - 183
Electronic File
EF23-12989
Certified Food Manager (CFM) Food Handler Program - Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12987
Certified Food Manager (CFM) Certificate - Renewal/Replacement Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12981
Food Manufacturer-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12978
Food Wholesaler License-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12977
Food Wholesaler Registration-Initial, Renewal, or Change of Ownership (including legal entity)
Food Licensing -146
Electronic File
EF23-12976
Food Wholesaler Registration-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12972
Food Establishment Inspection Application
Food Licensing -146
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 33 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF23-12968
Crabmeat Processing Facility
Food Licensing -146
Electronic File
EF23-12967
Certificate of Freesale and Sanitation and/or Certificate of Origin
Food Licensing -146
Electronic File
E59-11866
Botulism (Botulinum Toxins)
Infectious Disease - 183
Electronic File
E59-11372
Foodborne Illness Box Locations
Infectious Disease - 431
Electronic File
E59-11371
Etiology of Foodborne Disease Outbreaks by Food and Season
Infectious Disease - 630
Electronic File
E59-11331
Safe Food Saves Lives
Infectious Disease - 630
Electronic File
E23-13198
FEGRC - No. 12: Bare Hand Contact with Ready-to-Eat Foods
Food Establishments - 811
Electronic File
E23-13251
FEGRC - No. 14: Service Animals in a Retail Food Establishment
Food Establishments - 811
Electronic File
E59-11116
Foodborne Illness Diagnostic Chart
Infectious Disease - 630
Electronic File
59-11116
Foodborne Illness Diagnostic Chart (fee for copies)
Infectious Disease - 35
Posters
E59-11094
Foodborne Disease Outbreak Manual
Infectious Disease - 431
Electronic File
E23-13297
Food Employee Reporting Sign
E23-13283
Food Establishment Inspection Sheet-General Marking Instructions
Food Establishments - 811
Electronic File
E23-13282
Model Form: No. 1-B-Conditional Employee and Food Employee Reporting Agreement
Food Establishments - 811
Electronic File
E23-13280
Variance Request Procedures
Food Establishments - 811
Electronic File
E59-11314
Campylobacteriosis in Texas
Infectious Disease - 183
Electronic File
E59-11370
Essential Epidemiology and Laboratory Components of a State Foodborne Disease Prev & Control Program
Infectious Disease - 431
Electronic File
E19-12248
What You Need to Know about Foodborne Illness
External Relations Communications - 545
Electronic File
E13-11908
The Risk of Eating Raw Oysters Fact Sheet
HIV/STD - 449
Fact Sheets
FEGRC - Frequently Asked Questions - Technical
Food Establishments - 812
Electronic File
E23-13199
Electronic File
Foods-Licensure / Autorizacion para alimentos EF23-10859
Childcare/School/Roadside Vendor/Mobile Unit Food Establishment Permit Application
Food Licensing -146
Electronic File
EF23-10853
Food Manufacturer License Application
Food Licensing -146
Electronic File
EF23-10603
Temporary Food Establishment Permit Application - 1 Event
Food Licensing -146
Electronic File
Forms / Formularios F75-13346
LPC Application Packet
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-11361
Professional Licensing & Certification Division Complaint General Release Form
Professional Licensing and Certification - 98
Forms
F76-10787
Speech-Language Pathology Course Work and Clinical Experience Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10784
Audiology Course Work and Clinical Experience Form
State Bd of Examiners Speech & Audiology - 129
Forms
F75-13407
Verification of Licensure in Other Jurisdiction (Professional Counselor)
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-13345
Course Evaluation / Licensing Information Sheet
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-11360
Professional Licensing & Certification Division Complaint Form
Professional Licensing and Certification - 98
Forms
F75-11220
Professional Licensing and Certification Division - Complaint Packet
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-10967
St Bd of Exam of Prof CounselorsSupervisory Agreement Form
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
Stock #4-25-lang Revised 10/25/2010
Page 34 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F76-10788
St Bd Exam for Speech-Lang Pathology and Audiology-Alt Meth for Assistant to Obtain Clinical Observ
State Bd of Examiners Speech & Audiology - 129
Forms
F75-10963
St Bd of Exam of Prof Counselors-Supervised Experience Documentation Form
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F76-10797
St Bd Exam for Speech-Lang Pathology and Audiology-Superv Resp Statement for Assts
State Bd of Examiners Speech & Audiology - 129
Forms
F75-10962
St Bd of Exam of Prof Counselors-Practicum Documentation
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-10781
St Bd of Examiners of Prof Counselors-Pre-Approved Cont Educ Prov Appl
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-10759
St Bd Exam of Professional Counselors - Counselor Cont Education Declaration
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-10757
Licensed Professional Counselor - Application Packet
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-10966
St Bd of Exam of Prof Counselors-Supervisor Application Form
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F77-13400
Clinical Supervision Plan (Form III)
Tx State Bd of Social Worker Examiners - 337
Forms
F76-13408
Alternate Supervision of an Assistant Request Plan
State Bd of Examiners Speech & Audiology - 129
Forms
F76-12586
Application to Upgrade Intern License to Full Licensure
State Bd of Examiners Speech & Audiology - 129
Forms
F76-12382
Exception Request to Supervising More than Four Interns/Assistants (Speech-Language Pathology)
State Bd of Examiners Speech & Audiology - 129
Forms
F76-12381
Exception Request to Supervising with Less Than Three Years Experience (Speech-Language Pathology)
State Bd of Examiners Speech & Audiology - 129
Forms
F76-11177
Continuing Education--College University Course Work Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-11176
Rating Scale of Assistant's Performance Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-11175
Clinical Deficiency Plan Completion of Training for Assistants Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-11163
Felony/Misdemeanor Evaluation Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-11145
Request to Change Name Form (Speech)
State Bd of Examiners Speech & Audiology - 129
Forms
F77-10801
ACP/AP Supervision Forms Packet (Texas State Board of Social Worker Examiners)
Tx State Bd of Social Worker Examiners - 93
Forms
F76-10795
St Bd Exam for Speech-Lang Pathology and Audiology-Rec of Cont Educ Hrs Earned Used
State Bd of Examiners Speech & Audiology - 129
Forms
F77-13336
Form V-Clinical Supervision Verification for LCSW
Tx State Bd of Social Worker Examiners - 93
Forms
F76-10789
St Bd Exam for Speech-Lang Pathology and Audiology - Application Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10910
Late Renewal Form (Speech)
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10909
Inactive Status Form (Speech)
State Bd of Examiners Speech & Audiology - 129
Forms
F73-10752
Tx St Bd of Examiners of Marriage and Family Therapists Supervisor Application
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F74-13387
Perfusionist Application Packet
Tx State Bd of Examiners of Perfusionists - 135
Forms
F77-13401
Non-Clinical Supervision Plan (Form IV)
Tx State Bd of Social Worker Examiners - 337
Forms
Stock #4-25-lang Revised 10/25/2010
Page 35 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F77-13402
Board-Ordered Supervision Plan (Form IX)
Tx State Bd of Social Worker Examiners - 337
Forms
F76-10798
Supervision Log - Speech-Language Pathology and Audiology
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10796
St Bd Exam for Speech-Lang Pathology and Audiology - Report of Completed Internship Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10793
St Bd Exam for Speech-Lang Pathology and Audiology - Intern Plan & Agreement of Sup Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10792
St Bd Exam for Speech-Lang Pathology and Audiology-Fitting & Disp of Hearing Instr Reg
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10790
St Bd Exam for Speech-Lang Pathology and Audiology-Clinical Observ & Exp for Assts. Form
State Bd of Examiners Speech & Audiology - 129
Forms
F77-10802
Texas State Board of Social Worker Examiners - CEU Provider Appl Proc Packet
Tx State Bd of Social Worker Examiners - 93
Forms
F70-10737
Texas Board of Licensure for Professional Medical Physicists License Appl Packet
Tx Bd Licensure for Prof. Medical Physicists - 134
Forms
F73-12959
Form I-Course Equivalency Request (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
Z-3
Registration Inspection - Rabies Quarantine Facility/Animal Shelter Facility
Warehouse
Forms
zooform
Report of Zoonotic Disease in Animals
Zoonosis - 633
Electronic File
F73-10751
Tx St Bd of Examiners of Marriage & Family Therapists -Supervised Experience Doc Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-10748
Texas State Board of Examiners of Marriage & Family Therapists Application Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-10747
Texas State Board of Examiners of Marriage & Family Therapists References Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F72-12124
Dietitian Renewal Form
Tx State Bd of Examiners of Dietitians - 127
Forms
F72-10745
Dietitian Application for Licensure
Tx State Bd of Examiners of Dietitians - 127
Forms
F71-11503
Orthotics & Prosthetics Board Continuing Education (CE) Report Form
Tx Bd of Orthotics & Prosthetics - 130
Forms
WIC-53EBT
Sample Formula Log EBT Form (restricted to WIC Local Agencies)
F71-10740
Texas Board of Orthotics and Prosthetics - Facility Accreditation Application Packet
WIC-52EBT
Returned Formula Log EBT Form (Restricted to WIC Local Agencies)
F69-13399
Application for Continuing Education Sponsor (Hearing Instruments)
St. Comm. Examrs. In Fit & Disp. Hear Instr - 126
Forms
F69-13310
Application Form License Holder from Another State
St. Comm. Examrs. In Fit & Disp. Hear Instr - 126
Forms
F69-11751
Hearing Instrument Fitters and Dispensers Complaint Reporting Form
St. Comm. Examrs. In Fit & Disp. Hear Instr - 126
Forms
F69-10733
State Comm of Exam in Fitting & Disp of Hearing InstrumentsApplication Form
St. Comm. Examrs. In Fit & Disp. Hear Instr - 126
Forms
F68-13333
Practioner of Respiratory Care State Certification/Registration Verification Form
Respiratory Care Pract. Certif. Program - 843
Forms
F68-10730
Respiratory Care Practitioners Certif Program - Late Renewal Deficiency Notification
Respiratory Care Pract. Certif. Program - 843
Forms
F68-10729
Respiratory Care Practitioners Certification Program - Exam Score Release Form
Respiratory Care Pract. Certif. Program - 843
Forms
Stock #4-25-lang Revised 10/25/2010
Forms Tx Bd of Orthotics & Prosthetics - 130
Forms Forms
Page 36 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F68-10726
Respiratory Care Practitioners Application Packet
Respiratory Care Pract. Certif. Program - 843
Forms
F67-12090
Statement of Continuing Education Form for Opticians
Optician's Registry Program - 133
Forms
F67-10722
Opticians Registry - Application for Optician Registration
Optician's Registry Program - 133
Forms
F71-10741
Texas Board of Orthotics and Prosthetics - Licensure Application Packet
Tx Bd of Orthotics & Prosthetics - 130
Forms
WIC-35-1
WIC Supplemental Information Form
Nutrition Services - 885
Forms
F73-12965
Form VII-Examination Security Information Acknowledgement Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-12964
Form VI-Supervised Clinical Practicum Supervision and Experience Verification Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-12963
Form B-Continuing Education Provider Approval Application/Renewal (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-12962
Form B-Texas State Board of Marriage and Family Therapists Renewal Application Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-12961
Form IV-Probation/Monitoring Supervision Plan (for licensees under board ordered supervision)
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-12960
Form II-Verification of Licensure in Other Jurisdiction (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F82-11153
Code Enforcement Officer Examination Request Form
Code Enforcement Officers - 186
Forms
F73-10753
Tx St Bd of Examiners of Marriage and Family Therapists Supervisory Agreement Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F82-11947
Commercial Education Business Continuing Education Provider Application/Agreement (Prof Sanitarian)
Registered Sanitarian - 36
Forms
WIC-54EBT
Donated Formula Log EBT Form (Restricted to WIC Local Agencies)
WIC-35
Family Certification Form (Replaced WIC-19)
Nutrition Services - 885
Forms
F74-10755
Licensed Perfusionist or Provisional Licensed Perfusionist
Tx State Bd of Examiners of Perfusionists - 135
Forms
WIC-36
Infant Participant Form (Replaced WIC-11)(restricted to Texas WIC Local Agencies)
Nutrition Services - 885
Forms
WIC-37
Quick Intake/In-State Transfer Form
Nutrition Services - 885
Forms
WIC-38
Child Participant Form (Replaced WIC-11) (restricted to Texas WIC Local Agencies)
Nutrition Services - 885
Forms
WIC-39
Pregnant Women Participant (Replaced WIC-11) (restricted to Texas WIC Local Agencies)
Nutrition Services - 885
Forms
WIC-4
Range of Prenatal Weight Gain
Nutrition Services - 885
Forms
WIC-40
Breastfeeding Participant Form (Replaced WIC-11) (restricted to Texas WIC Local Agencies)
Nutrition Services - 885
Forms
WIC-41
Postpartum Participant Form (Replaced WIC-11) (restricted to Texas WIC Local Agencies)
Nutrition Services - 885
Forms
WIC-4-1
Prenatal Weight Gain Grid Multi
Nutrition Services - 885
Forms
WIC-50
Single-User Breast Pump Release Form (Restricted to WIC local agencies)
Forms
WIC-51
Multi-User Breast Pump Loan/Release Form (Restricted to WIC local agencies)
Forms
Stock #4-25-lang Revised 10/25/2010
Forms
Page 37 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
WIC-32
Applicant's Statement of Farm/Self-Employment
Nutrition Services - 885
Forms
GC-11
Nonexpendable Personal Property
Contract Oversight/Support - 592
Forms
KHC-3
Kidney Health Care-Transporation Claim Form
Kidney Health Care - 179
Forms
J-41
Lot Folder Status Sheet
Warehouse
Forms
Indu-Abor-Rpt
Induced Abortion Report Form
Vital Statistics - 346
Electronic File
Imm-TVFC
Hurricane Relief - Vaccine Agreement Form
Immunization - 562
Electronic File
Imm-TempProv
Emergency Provisional Enrollment for Victims of Hurricane Katrina (immunization)
Immunization - 562
Electronic File
HYPGEN
Hypothesis Generating Questionnaire for Gastroenteritis Complaints
Infectious Disease - 185
Electronic File
HHS-FL02
Vehicle Incident Report Form (HHS form)
Risk Management/Safety Office - 259
Electronic File
HHS-ECPS.02
Justification for Proprietary and/or Sole Source Purchase
Enterprise Procurement 729
Electronic File
HHS-ECPS.01
Justification for Emergency Purchase
Enterprise Procurement 729
Electronic File
HHS-687
Consent for Sterilization (Federal form: Health & Human Services)
federal form - 646
Electronic File
HD-400
Texas Hansen's Disease Encounter Form
Hansen's Disease - 83
Forms
F82-11518
Statement of Continuing Education (Registered Sanitarian)
Registered Sanitarian - 36
Forms
GenProbe-form
Order Form-GenProbe Collectors
Labs - 578
Electronic File
Med-Cert-HIV
Texas HIV Medication Program Medical Certification Form
HIV/STD - 410
Forms
GC-10
Request for Advance or Reimbursement (270)
Warehouse
Forms
G-9
Rabies Submission Form (Laboratory Test for Rabies)
Labs - 30
Forms
G-6A
Order Form-Containers and Forms, Labels & Kits
Labs - 30
Forms
G-399
THSteps/Child Health Laboratory Supplies Form
Labs - 30
Forms
G-2B
Bacteriology and Parasitology Specimen Submission Form
Labs - 388
Forms
G-2A
Serology and Virology Specimen Submission Form
Labs - 388
Forms
G-23
Food Sample Form
Labs - 30
Forms
G-22
Consumer Health Form
Warehouse
Forms
G-21RR
Grade "A" Raw for Retail Dairy
Milk Group - 746
Forms
G-21Path
Grade "A" Raw for Retail Dairy Pathogen Testing
Milk Group - 746
Forms
G-20
Texas DSHS Dairy Water Form
Milk Group - 746
Forms
G-1C
Maternal Serum Prenatal Triple Screen Specimen Submission Form
Labs - 388
Forms
H-68
Advisory Guidelines
Warehouse
Forms
STD-42
Disclosure and Consent Form
Warehouse
Forms
TB-203
Tuberculosis Education/Counseling Record
Warehouse
Forms
TB-205
Tuberculosis Elimination Toxicity Assessment
Warehouse
Forms
TB-206
Directly Observed Therapy Log
Warehouse
Forms
TB-207
Targeted Tuberculin Testing Screening Form
Warehouse
Forms
TB-202
Tuberculosis Health Assessment/History
Warehouse
Forms
TB-208
Tuberculosis Contact Screening Form
Warehouse
Forms
TB-220
Referral Form (TB)
Warehouse
Forms
TB-201
Case Management Plan for Outpatient Care
Warehouse
Forms
TAC139.52(a)(1)
Informed Consent Certification Form (Abortion Facilities)
Abortion Facility Licensing - 634
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 38 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
TAC139.41(a)(8)
Affidavit of Age Form (Abortion Facilities)
Abortion Facility Licensing - 634
Electronic File
T-1
Newborn Screening Thyroid specimens
Labs - 388
Forms
STD-6M
Sexually Transmitted Disease Record-Male
HIV/STD - 104
Forms
KHP-1
Kidney Health Care-Application for Benefits & Instruction
Kidney Health Care - 179
Forms
STD-43
Referral / Risk Reduction Step Form
HIV/STD - 561
Forms
M-71
Risk Criteria Checklist
Warehouse
Forms
STD-3
GC/Syph Serology Information Card
Warehouse
Forms
STD-28
Notification of Lab Test Findings
HIV/STD - 44
Forms
STD-27
Confidential Report of STD
Warehouse
Forms
STD-1
STD Envelope Label
Warehouse
Forms
Smear/biopsy
Skin Smear/Biopsy Chart
Infectious Disease - 629
Electronic File
PKU-orderform
Order Form-PKU Monitoring Lab Supplies
Labs - 578
Electronic File
PB-104
Physician Checklist for Parent Education Topics
Warehouse
Forms
PB-103
Environmental Investigation Questionnaire (Childhood Lead Poisoning Prevention Prog)
Childhood Lead Poisoning - 379
Forms
MSA-13
Operators Rendering Application
Drugs & Food Safety Licensing - 89
Electronic File
MSA-12
Construction Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
MHRS9-7
Consent to Treatment with Psychoactive Medication
Hospitals Section - 515
Forms
G-194
Newborn Screening Specimen Collection (NBS Specimen Collection)
Labs - 30
Forms
STD-6F
Sexually Transmitted Disease Record-Female
HIV/STD - 104
Forms
FVS-116
Burial-Transit Permit (restricted distribution)
Vital Statistics - 71
Forms
G-1B
Specimen Submission Form (Clinical ChemistryTesting)
Labs - 388
Forms
FVS-166
Application for Amended Birth Certificate Based on Parentage
Vital Statistics - 71
Forms
FVS-165
Suits Affecting Parent Child Relationship (Information on Suit Affecting the Family Relationship)
Vital Statistics - 71
Forms
FVS-160
Certificate of Adoption (for District Clerks)
Vital Statistics - 71
Forms
FVS-159.1M
Acknowledgement of Paternity
Vital Statistics - 71
Forms
FVS-141.4
Genealogical Sheet
Vital Statistics - 71
Forms
FVS-141
Application for Certified Copy of Birth or Death Certificates (Birth Certificate)
Vital Statistics - 71
Forms
FVS-140
Authorization Form to Issue Birth/Death Certificates (Birth Certificate)
Vital Statistics - 71
Forms
FVS-134.1
Acknowledgement of Paternity Inquiry Request
Vital Statistics - 71
Forms
FVS-134
Paternity Registry Inquiry Request
Vital Statistics - 71
Forms
FVS-132
Revocation of Notice of Intent to Claim Paternity
Vital Statistics - 71
Forms
FVS-131
Paternity Registry Notice of Change of Information
Vital Statistics - 71
Forms
FVS-170
Application to Amend Certificate of Birth (Birth Certificate)
Vital Statistics - 71
Forms
FVS-128
Court-Ordered Delayed Certificate of Death
Vital Statistics - 71
Forms
FVS-172
Application to Amend Certificate of Death
Vital Statistics - 71
Forms
FVS-115
Report of Death
Vital Statistics - 71
Forms
FVS-113
Certificate of Fetal Death
Vital Statistics - 71
Forms
FVS-112
Certificate of Death
Vital Statistics - 71
Forms
Stock #4-25-lang Revised 10/25/2010
Page 39 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
FVS-111
Certificate of Birth (2005) Long form (restricted distribution) (Birth Certificate)
Vital Statistics - 71
Forms
FVS-109.2
Medical Data Worksheet for Child's Birth Certificate
Vital Statistics - 71
Forms
FVS-109.1
Mother's Worksheet for Birth Certificate (2005)
Vital Statistics - 71
Forms
FVS-101
Batch Control Form
Vital Statistics - 71
Forms
TB-204
Forms/Literature Checklist
Warehouse
Forms
F82-11543
Sanitarian Application for Registration
Registered Sanitarian - 36
Forms
F82-11517
Statement of Continuing Education (Code Enforcement)
Code Enforcement Officers - 186
Forms
F82-11487
Replacement Registration Affidavit-Registered Sanitarian
Registered Sanitarian - 36
Forms
F82-11486
Replacement Registration Affidavit-Code Enforcement
Code Enforcement Officers - 186
Forms
FVS-130
Notice of Intent to Claim Paternity
Vital Statistics - 71
Forms
TB-400B
Report of Case/Patient Services, Part B (Limit order 500)
Warehouse
Forms
F82-11154
Application Packet for Registration as a Code Enforcement Officer or a Code Enf Officer-In-Training
Code Enforcement Officers - 186
Forms
G-19
Water Bacteriology Specimen Submission Form
Labs - 30
Forms
G-14
Mosquito Surveillance Adult/Larval Submission Form
Labs - 30
Forms
FVS-301
Certificate of Birth Resulting in Stillborn Application (Birth Certificate)
Vital Statistics - 71
Forms
FVS-271.1
Disinterment Consent Form (Vital Statistics)
Vital Statistics - 71
Forms
FVS-271
Application for Disinterment Permit (Vital Statistics)
Vital Statistics - 71
Forms
FVS-2318.1A
Application for Amended Birth Certificate based on a Court-Ordered Change of Name
Vital Statistics - 71
Forms
TB-231
Bacteriology TB Control
Warehouse
Forms
TB-280
Chest Clinic Appointment Card
Warehouse
Forms
TB-318
Positive Reactor Worksheet
Warehouse
Forms
TB-340
Report of TB Contacts (Limit order 500)
Warehouse
Forms
TB-341
Continuation of Report of Contacts (Limit order 500)
Warehouse
Forms
FVS-168
Inquiry on Court of Continuous Jurisdiction for a Child
Vital Statistics - 71
Forms
F65-10711
Medical Radiologic Technologist Certification - Appl for Hardship Exemption
Medical Radiologic Technologist Certif Prog 123
Forms
G-1A
Specimen Submission Form (Bacteriology Testing)
Labs - 388
Forms
TB-411
Disclosure and Consent for Drug Therapy-TB
Warehouse
Forms
TB-412
Tuberculosis Surveillance Form
Warehouse
Forms
TB-415
Disclosure and Consent Drug Therapy for Treatment of Latent Tuberculosis (TB) Infection
Warehouse
Forms
TB-621
Preventive Treatment Record
Infectious Disease Control Unit - TB - 253
Forms
TB-622
Treatment Record
Infectious Disease Control Unit - TB - 253
Forms
TB-supplies
Order Form-TB Supplies
Labs - 578
Electronic File
WHR-7
Maternity Clinic Appointment Card
Warehouse
Forms
WIC-19B
WIC Employment Verification Form
Nutrition Services - 885
Forms
EF67-12090
Statement of Continuing Education Form for Opticians
Optician's Registry Program - 502
Electronic File
FVS-180.1
Declaration and Registration of Informal Marriage
Vital Statistics - 71
Forms
Stock #4-25-lang Revised 10/25/2010
Page 40 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
FVS-180
Application for Marriage License
Vital Statistics - 71
Forms
FVS-174
Amendment to Medical Certification of Certificate of Death
Vital Statistics - 71
Forms
TB-400A
Report of Case/Patient Services, Part A (Limit order 500)
Warehouse
Forms
ETB-202
Tuberculosis Health Assessment/History
Infectious Disease Control Unit - TB - 320
Electronic File
EF75-13345
Course Evaluation / Licensing Information Sheet
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EPHC-301
Performance Indicators Report Summary (Title V)
Title V - 542
Electronic File
EF76-11175
Clinical Deficiency Plan Completion of Training for Assistants Form
State Bd of Exam of Speech & Audiology - 213
Electronic File
ESTD-28
Notification of Laboratory Test Findings Indicating Presence of Chlamydia Trachomatis, Gonorrhea,...
HIV/STD - 734
Electronic File
EF76-11163
Felony/Misdemeanor Evaluation Form
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF76-11145
Request to Change Name Form (Speech)
State Bd of Exam of Speech & Audiology - 213
Electronic File
EPHC-200
Primary Health Care Monthly Report Form
Title V - 542
Electronic File
ETB-201
TB Case and Suspect Management Plan for Outpatient Care
Infectious Disease Control Unit - TB - 320
Electronic File
EPB-104
Physician Checklist for Parent Education Topics
Childhood Lead Poisoning - 385
Electronic File
EF76-10910
Late Renewal Form (Speech)
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF76-10909
Inactive Status Form (Speech)
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF75-13407
Verification of Licensure in Other Jurisdiction (Professional Counselor)
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
ETB-203
Tuberculosis Education/Counseling Record
Infectious Disease Control Unit - TB - 320
Electronic File
EF75-13346
LPC Application Packet
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EL-39
Statement of Services (no print copy available)
Public Health Nursing - 263 Electronic File
ESTD-42
Disclosure and Consent Form
HIV/STD - 734
Electronic File
EF76-13408
Alternate Supervision of an Assistant Request Plan
State Bd of Exam of Speech & Audiology - 213
Electronic File
ETB-400A
Report of Case/Patient Services, Part A
Infectious Disease Control Unit - TB - 320
Electronic File
EF77-13400
Clinical Supervision Plan (Form III)
Tx State Bd of Social Worker Examiners - 857
Electronic File
EF77-13336
Form V-Clinical Supervision Verification for LCSW
Tx State Bd of Social Worker Examiners - 845
Electronic File
EM-72
State of Texas Purchase Voucher (PACT version) (Providers only can order from web site)
Audiology - 440
Forms
EM-76
Report of Otological Examination
Audiology - 440
Electronic File
EM-77
Hearing Aid Evaluation Report
Audiology - 440
Electronic File
EPHC-300
Annual Demographic Report (Title V)
Title V - 542
Electronic File
EF77-10801
ACP/AP Supervision Forms Packet (Texas State Board of Social Worker Examiners)
Tx State Bd of Social Worker Examiners - 358
Electronic File
ETB-205
Clinical Assessment for Medication Toxicity
Infectious Disease Control Unit - TB - 320
Electronic File
EF76-12586
Application to Upgrade Intern License to Full Licensure
State Bd of Exam of Speech & Audiology - 213
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 41 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EPB-101
Request for Environmental Investigation (Childhood Lead Poisoning Prevention Prog)
Childhood Lead Poisoning - 385
Electronic File
EF76-12382
Exception Request to Supervising More than Four Interns/Assistants (Speech-Language Pathology)
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF76-12381
Exception Request to Supervising with Less Than Three Years Experience (Speech-Language Pathology)
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF76-11176
Rating Scale of Assistant's Performance Form
State Bd of Exam of Speech & Audiology - 213
Electronic File
EPB-102
Provider Questionnaire (Childhood Lead Poisoning Prevention Prog)
Childhood Lead Poisoning - 385
Electronic File
Emerg-ADAP
Emergency Relief ADAP Application (Hurricane Katrina)
HIV/STD - 560
Electronic File
ETB-341
Continuation of Report of Contacts
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-204
Tuberculosis Forms/Literature Checklist
Infectious Disease Control Unit - TB - 320
Electronic File
EF73-12962
Form B-Texas State Board of Marriage and Family Therapists Renewal Application Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-12961
Form IV-Probation/Monitoring Supervision Plan (for licensees under board ordered supervision)
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-12960
Form II-Verification of Licensure in Other Jurisdiction (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
ETB-220
Referral Form (TB)
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-231
Bacteriology TB Control
Infectious Disease Control Unit - TB - 320
Electronic File
EF73-12964
Form VI-Supervised Clinical Practicum Supervision and Experience Verification Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
ETB-340
Report of TB Contacts
Infectious Disease Control Unit - TB - 320
Electronic File
EF73-12965
Form VII-Examination Security Information Acknowledgement Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-12959
Form I-Course Equivalency Request (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-12433
MFT CE Provider Approval Application/Renewal Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-10753
Tx St Bd of Examiners of Marriage and Family Therapists Supervisory Agreement Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-10752
Tx St Bd of Examiners of Marriage and Family Therapists Supervisor Application
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-10751
Tx St Bd of Examiners of Marriage & Family Therapists -Supervised Experience Doc Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF77-13401
Non-Clinical Supervision Plan (Form IV)
Tx State Bd of Social Worker Examiners - 857
Electronic File
ETB-318
Tuberculin Skin Test Pediatric Positive Reactor Worksheet
Infectious Disease Control Unit - TB - 320
Electronic File
F65-13344
Affidavit for Continuing Education Exemption (Medical Radiologic Technologist)
Medical Radiologic Technologist Certif Prog 123
Forms
Stock #4-25-lang Revised 10/25/2010
Page 42 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF75-11361
Professional Licensing and Certification Division Complaint General Release Form
Professional Licensing and Certification - 246
Electronic File
ETB-206
Directly Observed Therapy Log
Infectious Disease Control Unit - TB - 320
Electronic File
EF75-11360
Professional Licensing and Certification Division Complaint Form
Professional Licensing and Certification - 246
Electronic File
ETB-207
Targeted Tuberculin Testing Screening Form
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-208
Tuberculosis Contact Screening Form
Infectious Disease Control Unit - TB - 320
Electronic File
EF75-11220
Professional Licensing and Certification Division - Complaint Packet
Professional Licensing and Certification - 246
Electronic File
EF73-12963
Form B-Continuing Education Provider Approval Application/Renewal (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 460
Forms
EF75-10966
St Bd of Exam of Prof Counselors-Supervisor Application Form
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EL-29
Referral Form (no print copy available)
Public Health Nursing - 263 Electronic File
EF75-10963
St Bd of Exam of Prof Counselors-Supervised Experience Documentation Form
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
F66-13412
Supervising Midwife/Apprentice Complaint Disclosure Form
Midwifery Program - 124
Forms
EF75-10962
St Bd of Exam of Prof Counselors-Practicum Documentation
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF75-10781
St Bd of Examiners of Prof Counselors-Pre-Approved Cont Educ Prov Appl
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF75-10757
Licensed Professional Counselor - Application Packet
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF74-13387
Perfusionist Application Packet
Tx State Bd of Examiners of Perfusionists - 853
Electronic File
EF75-10967
St Bd of Exam of Prof CounselorsSupervisory Agreement Form
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EFVS-142.61
Application for Birth or Death Verification (credit card payment)
Vital Statistics - 346
Electronic File
EFVS-146
Application for an Heriloom Wedding Anniversary Certificate
Vital Statistics - 346
Electronic File
EFVS-134.1
Acknowledgement of Paternity Inquiry Request
Vital Statistics - 346
Electronic File
EFVS-141
Application for Certified Copy of Birth or Death Certificates (Birth Certificate)
Vital Statistics - 760
Forms
EFVS-142.2
Expedited Application for a Certified copy of a Birth or Death Record (fax) (Birth Certificate)
Vital Statistics - 346
Electronic File
EFVS-142.21
Expedited Application for Birth or Death Record - Certified (credit card)(Birth Certificate)
Vital Statistics - 346
Electronic File
EFVS-142.3
Mail Application for a Certified copy of a Birth or Death Record (Birth Certificate)
Vital Statistics - 346
Electronic File
EFVS-133
Denial of Registrants' Paternity
Vital Statistics - 760
Electronic File
EFVS-142.6
Mail Application for a Verification of a Birth or Death Record (Birth Certificate)
Vital Statistics - 346
Electronic File
EFVS-132
Revocation of Notice of Intent to Claim Paternity
Vital Statistics - 760
Electronic File
EFVS-142.7
Application for Birth Record - Certified - Military Personnel Being Deployed (Birth Certificate)
Vital Statistics - 346
Electronic File
EFVS-142.9
Mail Application for a Verification of Marriage and Divorce
Vital Statistics - 346
Electronic File
EFVS-142.91
Application for Marriage or Divorce Verification (credit card payment)
Vital Statistics - 346
Electronic File
EFVS-143
Request for Identity of Court of Adoption
Vital Statistics - 346
Electronic File
EFVS-144
Heirloom Gift Certificate (Vital Statistics)
Vital Statistics - 346
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 43 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EM-71
Risk Criteria Checklist
Audiology - 440
Electronic File
EFVS-142.31
Application for Birth or Death Record - Certified (credit card) (Birth Certificate)
Vital Statistics - 346
Electronic File
EF82-12232
Professional Sanitarian Renewal Form
Registered Sanitarian - 242
Electronic File
EF77-13402
Board-Ordered Supervision Plan (Form IX)
Tx State Bd of Social Worker Examiners - 857
Electronic File
EF82-11153
Code Enforcement Officer Examination Request Form
Code Enforcement Officers - 219
Electronic File
EF82-11154
Application Packet for Registration as a Code Enforcement Officer or Code Enf Officer In-training
Code Enforcement Officers - 219
Electronic File
EF82-11486
Replacement Registration Affidavit-Code Enforcement
Code Enforcement Officers - 219
Electronic File
EF82-11487
Replacement Registration Affidavit-Registered Sanitarian
Registered Sanitarian - 242
Electronic File
EF82-11543
Sanitarian Application for Registration
Registered Sanitarian - 242
Electronic File
EFVS-134
Paternity Registry Inquiry Request
Vital Statistics - 346
Electronic File
EF82-12231
Code Enforcement Officer Renewal Form
Code Enforcement Officers - 219
Electronic File
EFVS-160
Certificate of Adoption (for District Clerks)
Vital Statistics - 346
Electronic File
EFVS-100
Requisition for Texas Vital Statistics Forms
Vital Statistics - 71
Electronic File
EFVS-109.1
Mother's Worksheet for Birth Certificate (2005)
Vital Statistics - 758
Electronic File
EFVS-109.2
Medical Data Worksheet for Child's Birth Certificate
Vital Statistics - 758
Electronic File
EFVS-115
Report of Death
Vital Statistics - 759
Electronic File
EFVS-130
Notice of Intent to Claim Paternity
Vital Statistics - 760
Electronic File
EFVS-131
Paternity Registry Notice of Change of Information
Vital Statistics - 760
Electronic File
EF82-11947
Commercial Education Business Continuing Education Provider Application/Agreement (Prof Sanitarian)
Registered Sanitarian - 242
Electronic File
EHDC-400
Texas Hansen's Disease Suspect/Contact Screen
Infectious Disease - 629
Electronic File
EFVS-145
Adult Adoptee Application for Non-Certified copy of Original Birth Certificate
Vital Statistics - 346
Electronic File
EGC-10
Request for Advance or Reimbursement (270)
Accounting-Claims - 660
Electronic File
EGC-11
Nonexpendable Personal Property
Contract Oversight/Support - 591
Electronic File
EGC-4A
Financial Status Report (269a)
Accounting-Claims - 660
Electronic File
EH-17
Renovation/New Construction Inspection Checklist
Inspection Unit - 825
Forms
EH-19
Deficiency Notice
Warehouse
Forms
EG-6B
Order Form-Title V/SDI-Containers and Forms, Labels and Kits (2 order forms per page)
Labs - 578
Electronic File
EHD-400
Texas Hansen's Disease Encounter Form
Infectious Disease - 629
Electronic File
EG-6A
Order Form-Containers and Forms, Labels and Kits (2 order forms per page)
Labs - 578
Electronic File
EJ-6
Disclosure and Consent for HIV
HIV/STD - 734
Electronic File
EKHC-3
Kidney Health Care-Transportation Claim Form
Kidney Health Care - 180
Electronic File
EKHP-1
Kidney Health Care-Application for Benefits
Kidney Health Care - 180
Electronic File
EKHP-1B
Kidney Health Care-Instructions for Application for Benefits
Kidney Health Care - 180
Electronic File
EKHP-1C
Kidney Health Care-Residency Documents
Kidney Health Care - 180
Electronic File
EL-2
Nurses' Daily Report (no print copy available)
Public Health Nursing - 263 Electronic File
EHCFA-1513
Disclosure of Ownership and Control Interest Statement
Client Services Contract Unit - 774
Stock #4-25-lang Revised 10/25/2010
Electronic File
Page 44 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EFVS-180.1
Declaration and Registration of Informal Marriage
Vital Statistics - 760
Electronic File
EFVS-165
Suits Affecting Parent Child Relationship (Information on Suit Affecting the Family Relationship)
Vital Statistics - 760
Electronic File
EFVS-166
Application for New Birth Certificate Based on Parentage
Vital Statistics - 346
Electronic File
EFVS-166.531
Adoption Validation Petition (for District Clerks)
Vital Statistics - 346
Electronic File
EFVS-166.532
Adoption Validation Order (for District Clerks)
Vital Statistics - 346
Electronic File
EFVS-168
Inquiry on Court of Continuous Jurisdiction for a Child
Vital Statistics - 760
Electronic File
EFVS-170
Application to Amend Certificate of Birth (Birth Certificate)
Vital Statistics - 346
Electronic File
EG-9
Rabies Submission Form (Laboratory Test for Rabies)
Labs - 578
Electronic File
EFVS-180
Application for Marriage License
Vital Statistics - 760
Electronic File
EF73-10747
Texas State Board of Examiners of Marriage & Family Therapists References Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EFVS-2318.1A
Application for Amended Birth Certificate based on a Court Ordered Name Change
Vital Statistics - 346
Electronic File
EFVS-271
Application for Disinterment Permit (Vital Statistics)
Vital Statistics - 346
Electronic File
EFVS-271.1
Disinterment Consent Form (Vital Statistics)
Vital Statistics - 346
Electronic File
EFVS-301
Certificate of Birth Resulting in Stillborn Application (Birth Certificate)
Vital Statistics - 346
Electronic File
EG-19
Water Bacteriology Specimen Submission Form
Labs - 580
Electronic File
EG-399
THSteps/Child Health Laboratory Supplies Form (2 order forms per page)
Labs - 578
Electronic File
EFVS-172
Application to Amend Certificate of Death
Vital Statistics - 346
Electronic File
F21-13511
Instructor Application for Certification - Promotor(a)/Community Health Worker
Community Hlth Wrkr 370
Forms
F11-12887
Uniform Stamp Replacement Form (Yellow Fever)
Immunization - 293
Forms
F18-12058
Mold Training Instructor Reference Form
Indoor Air Quality - 553
Forms
F18-12082
Business Information Form (Asbestos Program)
Asbestos - 148
Forms
F18-12144
Mold Remediation Notification Form
PSQA-Envir Hazards - 405
Forms
F18-12249
Company Name Change (Environmental & Sanitation LicensingMold)
PSQA-Envir Hazards - 405
Forms
F20-11979
Youth Camp & Day Camp Application
Environ/Consumer Safety 15
Forms
F17-12576
Lead Notification Form
Envir Hlth Group - 689
Forms
F21-13510
Promotor(a)/Community Health Worker Application for Certification
Community Hlth Wrkr 370
Forms
F14-13230
Use and Storage of Newborn Screening Bloodspot Cards (Directive to Destroy)
Labs - 818
Forms
F21-13512
Promotor(a)/Community Health Worker Application for Certificate Renewal
Community Hlth Wrkr 370
Forms
F21-13513
Instructor Application for Certificate Renewal Promotor(a)/Community Health Worker
Community Hlth Wrkr 370
Forms
F21-13514
Training Program/Sponsoring Organization Application for Certification
Community Hlth Wrkr 370
Forms
F21-13515
Training Program/Sponsoring Organization Application for Certificate Renewal
Community Hlth Wrkr 370
Forms
F23-12526
Order Form - Tanning Warning Signs
Drugs & Medical Device 674
Forms
F25-11006
Annual Survey of Hospitals
Center for Health Statistics - 257
Forms
Stock #4-25-lang Revised 10/25/2010
Page 45 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information) Public Health Sanitation 341
Forms
F20-12376
Youth Camp Training Program Application
F13-06-13184
Texas Ten Step Applications
EF73-10748
Texas State Board of Examiners of Marriage & Family Therapists Application Form
F13-06-12805
VENA Family Documentation Form (restricted to Texas WIC Local Agencies)
F13-06-13101
Breastfeeding Follow-up Form
Forms
Forms Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
Forms
F13-06-13102
Breastfeeding Assessment and Counseling Form
Forms
F13-06-13103
Breast Pumping Log
Forms
F13-06-13104
How Do I Know Breastfeeding Is Going Well?
Forms
F18-12048
Mold Licensing Program Complaint Form
Indoor Air Quality - 553
Forms Forms
F13-06-13152
Texas WIC Medical Request for Formula/Food
F45-03729
Diabetic Eye Disease Tracking Form
Texas Diabetes Council 305
Forms
F13-12209
HIV/AIDS Testing History Case Report Addendum (formerly Form I - HIV Testing History)
HIV/STD - 104
Forms
F13-12210
HIV Testing History Interview Form (formerly Form II - HIV Testing History)
HIV/STD - 104
Forms
F13-12218
Member Statement of Confidentiality (HIV/STD)
HIV/STD - 104
Forms
F13-12219
Voluntary Guest Sign-In Form (HIV/STD)
HIV/STD - 104
Forms
F14-03252
Newborn Screening Supplies Order Form
Labs - 30
Forms
F14-11419
Triple Screen Diagnosis Request Form
Labs - 30
Forms
F13-06-13104A
Como puedo saber si va bien la lactancia materna (How Do I Know Breastfeeding Is Going Well?)
F64-13023
Continuing Education Provider Application/Agreement
Massage Therapy Program - 122
Forms
F63-10698
Request to Establish a Registry for a Health-related Occupation
Health-Related Services Registry - 132
Forms
F64-10699
Massage Therapy Establishment Application
Massage Therapy Program - 122
Forms
F64-10701
Massage Therapy Registration Application
Massage Therapy Program - 122
Forms
F64-10702
Massage Therapy Registration Program - Additional Program Application
Massage Therapy Program - 122
Forms
F64-10703
Massage Therapy Registration Program - Additional/New Main Location Appl
Massage Therapy Program - 122
Forms
F64-10704
Massage Therapy Reg Program-Appl for School-Based Massage Therapy Instr
Massage Therapy Program - 122
Forms
F25-11047
Annual Statement of Community Benefits Standard
SHCC - 23
Forms
F64-10707
Massage Therapy Registration Program - Seminar/Workshop Application
Massage Therapy Program - 122
Forms
F62-13348
Supervison Form
Council on Sex Offender Treatment - 118
Forms
F64-13388
Massage Therapy License Renewal Form
Massage Therapy Program - 122
Forms
F64-13389
Massage Therapy Instructor License Renewal Form
Massage Therapy Program - 122
Forms
F64-13397
Massage Therapy Educational Program Application for Basic 500Hour Program
Massage Therapy Program - 122
Forms
Stock #4-25-lang Revised 10/25/2010
Forms
Page 46 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F65-10710
Medical Radiologic Technologist Certification Application
Medical Radiologic Technologist Certif Prog 123
Forms
EF68-13333
Practioner of Respiratory Care State Certification/Registration Verification Form
Respiratory Care Pract. Certif. Program - 843
Electronic File
F65-13332
Application for Limited Education Program
Medical Radiologic Technologist Certif Prog 123
Forms
F64-10706
Massage Therapy Registration Program - Massage School/Ind Instructor Reg
Massage Therapy Program - 122
Forms
F60-12125
Athletic Trainer License Renewal Form
Advisory Board of Athletic Trainers - 121
Forms
F11-11974
Yellow Fever Vaccination Renewal Form (Public Health Regions)
Immunization - 293
Forms
F49-11629
Tier Two Paperwork Reduction Form (PRF)
Policy, Standards, & Quality Assurance Unit 100
Forms
F49-11630
Sample Training Roster (Model Employee Training Roster-Texas Hazard Communication Act)
Policy, Standards, & Quality Assurance Unit 100
Forms
F49-11634
Electronic Filing Cover Sheet for the Texas Tier Two Report
Policy, Standards, & Quality Assurance Unit 100
Forms
F50-12589
Infectious Disease Reporting Form
ERT-HSR 1 - 693
Forms
F59-10666
Contaminated Sharps Reporting Form
Infectious Disease - 35
Forms
F63-10696
Registry for Health-related Occupations Application Form
Health-Related Services Registry - 132
Forms
F60-10681
Athletic Trainer License Application Packet
Advisory Board of Athletic Trainers - 121
Forms
F62-13349
Application Cover Letter Form
Council on Sex Offender Treatment - 118
Forms
F60-13340
Athletic Trainer Application Packet
Advisory Board of Athletic Trainers - 121
Forms
F61-10683
Application for Contact Lens Disp Permit-Corp or Other Business Entity
Contact Lens Dispensing Permit Program - 131
Forms
F61-10684
Application for Contact Lens Disp Permit - Individual or Sole Proprietor
Contact Lens Dispensing Permit Program - 131
Forms
F62-10689
Reg Sex Offender Treatment Prov/Affiliate Sex Offender Treatment Prov Appl
Council on Sex Offender Treatment - 118
Forms
F62-10690
Sexual Abuser Treatment Program Questionnaire
Council on Sex Offender Treatment - 118
Forms
F62-13347
Contract of Supervision for ASOTP or PSOTP
Council on Sex Offender Treatment - 118
Forms
F41-11811
Hemophilia Assistance Program - Application for Assistance (Adults over 21)
Hemophilia Assistance 403
Forms
F59-91102
Legionellosis Case Report (Legionnaires' Disease Reporting Form)
Infectious Disease - 35
Forms
EWIC-40
Breastfeeding Participant Form (Replaced WIC-11)
Nutrition Services - 730
Electronic File
EWIC-54EBT
Donated Formula Blank Log (WIC) (Restricted to WIC Local Agencies)
Nutrition Services - 669
Electronic File
EWHR-IN
Women's Health Record Instructions
Perinatal/Maternal/Child 446
Electronic File
EWIC-35
Family Certification Form (Replaced WIC-19)
Nutrition Services - 401
Electronic File
EWIC-35-1
WIC Supplemental Information Form
Nutrition Services - 401
Electronic File
EWIC-35-3
WIC Income Questionnaire
Nutrition Services - 401
Electronic File
EWIC-36
Infant Participant Form (Replaced WIC-11)
Nutrition Services - 730
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 47 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EWHR-6
Provider Signature Sheet
Perinatal/Maternal/Child 446
Electronic File
EWIC-39
Pregnant Women Participant (Replaced WIC-11)
Nutrition Services - 730
Electronic File
EWHR-4
Pregnancy Test
Perinatal/Maternal/Child 446
Electronic File
EWIC-41
Postpartum Participant Form (Replaced WIC-11)
Nutrition Services - 730
Electronic File
EWIC-42
Health History for Infants
Nutrition Services - 730
Electronic File
EWIC-44
Health History for Children
Nutrition Services - 730
Electronic File
EWIC-45
Diet History for Pregnant/Breastfeeding/Postpartum Women
Nutrition Services - 730
Electronic File
EWIC-50
Single-User Breast Pump Release Form
Nutrition Services - 307
Electronic File
F12-13204
Texas Refugee Health Assessment Form
Refugee Health - 814
Forms
EWIC-38
Child Participant Form (Replaced WIC-11)
Nutrition Services - 730
Electronic File
ETB-410B
Order to Implement and Carry Out Measures for Children with TB/Orden para implementar medidas
Infectious Disease Control Unit - TB - 320
Electronic File
EF72-12124
Dietitian Renewal Form
Tx State Bd of Examiners of Dietitians - 508
Electronic File
EF72-10745
Dietitian Application for Licensure
Tx State Bd of Examiners of Dietitians - 508
Electronic File
EF69-13399
Application for Continuing Education Sponsor (Hearing Instruments)
St. Comm. Examrs. In Fit & Disp. Hear Instr - 279
Electronic File
EF69-13310
Application Form License Holder from Another State
St. Comm. Examrs. In Fit & Disp. Hear Instr - 279
Electronic File
EF69-11751
Hearing Instrument Fitters and Dispensers Complaint Reporting Form
St. Comm. Examrs. In Fit & Disp. Hear Instr - 279
Electronic File
ETB-400B
Report of Case/Patient Services, Part B
Infectious Disease Control Unit - TB - 320
Electronic File
EWHR-8
Headache Evaluation
Perinatal/Maternal/Child 446
Electronic File
ETB-410
Order to Implement and Carry Out Measures for a Client with TB
Infectious Disease Control Unit - TB - 320
Electronic File
F01-13065
EMS Provider License Certificate / Vehicle Authorization Replacement Request
EMS - 791
Forms
ETB-411
Disclosure and Consent Drug Therapy for Treatment of Tuberculosis Disease
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-415
Disclosure and Consent Drug Therapy for Treatment of Latent Tuberculosis (TB) Infection
Infectious Disease Control Unit - TB - 320
Electronic File
ETSL-disp-log
Records Disposition Log (Superceded by F32-12236)
Records Management - 204 Electronic File
EWHR-1
Education/Counseling Record
Perinatal/Maternal/Child 446
Electronic File
EWHR-2
Routine Supply Visit
Perinatal/Maternal/Child 446
Electronic File
EWHR-3
Obstetric Flow Record
Perinatal/Maternal/Child 446
Electronic File
ETB-409
Acknowledgement of Understanding (Tuberculosis Elimination)
Infectious Disease Control Unit - TB - 320
Electronic File
F11-11229
Quality Assurance On-site Evaluation Report Tool--Immunization Division
Immunization - 293
Forms
F09-11927
Human Pesticide Exposure Report Form
Pesticide Exposure Surv (PEST)- 702
Forms
F10-12888
2008 MPH Training Registration Form
Cancer Epi/Surv - 61
Forms
Symptom and Side Effects Monitoring Sheet: Schizophrenia
TIMA-Patient/Family Ed 585
Forms
F105-12316
Stock #4-25-lang Revised 10/25/2010
Page 48 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F105-12317
Symptom and Side Effects Monitoring Sheet- Depression
TIMA-Patient/Family Ed 585
Forms
F105-12318
Symptom and Side Effects Monitoring Sheet-Bipolar Disorder (Mania)
TIMA-Patient/Family Ed 585
Forms
F11-10949
Immunization Division Order Form
Immunization - 293
Forms
EWIC-51
Multi-User Breast Pump Loan/Release Form
Nutrition Services - 307
Electronic File
F11-11206
Memorandum of Understanding and Confidentiality Statement for Providers
Immunization - 293
Forms
F05-06832
Audiometer Loan Application
Audiometric Lab - 74
Forms
F11-11231
Texas Vaccines For Children Risk Assessment Tool
Immunization - 293
Forms
F11-11443
TVFC-Provider Withdrawal Form
Immunization - 293
Forms
F11-11755
Exclusion from Immunizations for Reasons of Conscience Affadavit Form (Conscientious Exemption)
Immunization - 293
Forms
F11-11971
Yellow Fever Vaccination Renewal Form (Providers)
Immunization - 293
Forms
F11-11972
Yellow Fever Vaccination Application Form (Providers)
Immunization - 293
Forms
F11-11973
Yellow Fever Vaccination Application Form (Public Health Regions)
Immunization - 293
Forms
F11-11205
ImmTrac Site Registration Form for Providers
Immunization - 293
Forms
F02-12271
Personal Emergency Response System (PERS) Providers Application for License
PERS Providers - 567
Forms
F01-13066
EMS Provider License Declaration Form
EMS - 791
Forms
F01-13067
EMS Provider License Application
EMS - 791
Forms
F01-13068
EMS Provider License Administrator Information
EMS - 791
Forms
F01-13069
EMS Provider License-Personnel
EMS - 791
Forms
F01-13070
EMS Provider Vehicle Form
EMS - 791
Forms
F01-13071
EMS Provider-Medical Director Information Form
EMS - 791
Forms
F09-11624
Adult Blood Lead Reporting Form
Blood Lead Epi - 862
Forms
F01-13072
EMS Provider License Notification/Changes
EMS - 791
Forms
F05-11770
Application for Formula Assistance (Limit 5)
Newborn Screening - 136
Forms
F02-12272
Personal Emergency Response System (PERS) Providers Certificate of Proof of Liability Insurance
PERS Providers - 567
Forms
F02-12273
Personal Emergency Response System (PERS) Providers Application for Registration
PERS Providers - 567
Forms
F02-13364
Licensed Chemical Dependency Counselor Intern Clinical Training Institution (CTI) Assessment Form
Licensed Chemical Dependency Counselor 534
Forms
F02-13440
Application for Licensure Dyslexia Therapist or Dyslexia Practitioners
Dyslexia Therapist - 876
Forms
F04-12310
Policy Clarification Form (Community Health Services)
Community Hlth Svs - 582
Forms
F05-02361
Spinal Screening Certification Card
Vision, Hearing and Spinal Screening - 276
Forms
EC-76
Vaccine Adverse Event Reporting System (VAERS)
Immunization - 781
Electronic File
EC-96
Meningococcal Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
EC-7
ImmTrac - DSHS Immunization Registry Consent Form
Immunization - 781
Electronic File
EC-90
Polio-What You Need to Know (IPV) (VIS)
Immunization - 781
Electronic File
EC-85
Pneumococcal Conjugate Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
EC-86
Pneumococcal Polysaccaride Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
Oral Polio Vaccine-What You Need to Know (VIS)
Immunization - 41
Electronic File
EC-89
Stock #4-25-lang Revised 10/25/2010
Page 49 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
ECH-1
Child Health History
Texas Health Steps - 284
Electronic File
EC-8
Withdrawal of Consent or Confirmation Form
Immunization - 887
Electronic File
EC-92
Measles, Mumps, and Rubella Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
EC-93
Inactivated Influenza Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
ECD-001
Drug Therapy for Treatment of Hansen's Disease
Infectious Disease - 629
Electronic File
EC-95
Hepatitis A Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
EC-97
Chickenpox Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
EC-99
Rabies-What You Need to Know (VIS)
Immunization - 781
Electronic File
ECD-011
Disclosure & Consent Skin Scraping for Hansen's Disease Cases or Suspects
Infectious Disease - 629
Electronic File
ECD-010
Disclosure and Consent Skin Biopsy for Hansen’s Disease Cases or Suspects
Infectious Disease - 629
Electronic File
E75-11362
Professional Licensing and Certification Division Complaint Form Instructions
Professional Licensing and Certification - 246
Electronic File
EC-94
Tetanus and Diphtheria-What You Need To Know (VIS)
Immunization - 781
Electronic File
EC-108
Haemophilus Influenza Type B Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
EF02-13364
Licensed Chemical Dependency Counselor Intern Clinical Training Institution (CTI) Assessment Form
Licensed Chemical Dependency Counselor 849
Electronic File
ECH-14
Dietary Recall and Assessment for Children 5 to 9, 24 Hours
Health Promotion - 642
Electronic File
E71-11503
Orthotics & Prosthetics Board Continuing Education (CE) Report Form
Texas Board of Orthotics and Prosthetics - 239
Electronic File
EAG-30
Texas Department of State Health Services Requisition for Office Supplies/Forms/Literature
Publications Management Program - 86
Electronic File
EB-13
State of Texas Purchase Voucher
Accounting-Claims - 660
Electronic File
EB-13A
Supporting Schedule for Contracts Requiring Match
Accounting-Claims - 660
Electronic File
EB-13X
Supporting Schedule for Title X Reimbursement Voucher
Accounting-Claims - 660
Electronic File
EAPB#5
Demolition/Renovation Notification Form
Envir Hlth-PSQA - 606
Electronic File
EC-106
Hepatitis B Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
EC-69
Texas Vaccine Loss Report Form
Immunization - 781
Electronic File
EC-109
Tetanus, Diphtheria and Pertusis (Tdap) Vaccine-What You need to know (VIS)
Immunization - 781
Electronic File
EC-11
School/Daycare Immunization Record
Immunization - 781
Electronic File
EC-114
HPV (Human Papillomavirus Vaccine) (Gardasil)-What You Need to Know (VIS)
Immunization - 41
Electronic File
EC-12
Texas Hansen’s Disease Surveillance Form and Case Report
Infectious Disease - 629
Electronic File
EC-33
Monthly Vaccine Report (Monthly Biological Report)
Immunization - 781
Electronic File
EC-5
First Responder/Family Member Withdrawal of Consent and Confirmation Form
Immunization - 887
Electronic File
EC-68-1
TVFC - Biological Order Form - Pediatric
Immunization - 781
Electronic File
EC-68-2
TVFC - Biological Order Form - Adult
Immunization - 781
Electronic File
EC-105
Temperature Recording Form
Immunization - 781
Electronic File
EF01-13071
EMS Provider-Medical Director Information Form
EMS - 792
Electronic File
EEPI-2
Initial Provider Infectious Disease Report (Communicable Disease Reporting Form)
Infectious Disease - 185
Electronic File
EF01-11421
Department of State Health Services Standard Out-of-Hospital Do Not Resuscitate Order (DNR)
EMS - 292
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 50 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
EF01-11816
Emergency Care Attendant Training Request
EMS- 411
Electronic File
EF01-13065
EMS Provider License Certificate / Vehicle Authorization Replacement Request
EMS - 792
Electronic File
EF01-13066
EMS Provider License Declaration Form
EMS - 792
Electronic File
EF01-13067
EMS Provider License Application
EMS - 792
Electronic File
EF01-13068
EMS Provider License Administrator Information
EMS - 792
Electronic File
EF02-12271
Personal Emergency Response System (PERS) Providers Application for License
PERS Providers - 568
Electronic File
EF01-13070
EMS Provider Vehicle Form
EMS - 792
Electronic File
ECORE-9
Client Follow-Up Health Record
Public Health Nursing - 263 Electronic File
EF01-13072
EMS Provider License Notification/Changes
EMS - 792
Electronic File
E6-102
Texas Vaccines for Children Program-Provider Enrollment Form
Immunization - 781
Electronic File
EF02-12273
Personal Emergency Response System (PERS) Providers Application for Registration
PERS Providers - 568
Electronic File
CIHCP Form 111
Payment Rate Request (County Indigent Health Care)
Indigent Health Program 421
Electronic File
EF02-13440
Application for Licensure Dyslexia Therapist or Dyslexia Practitioners
Dyslexia Therapist - 877
Electronic File
EF04-12310
Policy Clarification Form (Community Health Services)
Community Hlth Svs - 581
Electronic File
EF05-11573
Adolescent Health Exam Packet & Preventative Services Checklist (11-21 years)
Adolescent Health - 338
Electronic File
EF05-11770
Application for Formula Assistance
Newborn Screening - 281
Electronic File
EF01-13069
EMS Provider License-Personnel
EMS - 792
Electronic File
ECORE-2
Physical Exam (no print copy available)
Public Health Nursing - 263 Electronic File
ECH-2
Child Health Record, Birth -1 Month
Texas Health Steps - 284
Electronic File
ECH-22
Child Health Record, Medical Checkup Flowsheet
Texas Health Steps - 284
Electronic File
ECH-3
Child Health Record, 2 - 6 Months
Texas Health Steps - 284
Electronic File
ECH-4
Child Health Record, 7 - 12 Months
Texas Health Steps - 284
Electronic File
ECH-5
Child Health Record, 13 Months - 2 Years
Texas Health Steps - 284
Electronic File
ECH-6
Child Health Record, 3 - 5 Years
Texas Health Steps - 284
Electronic File
ECH-7
Child Health Record, 6 - 10 Years
Texas Health Steps - 284
Electronic File
ECORE-1
Client/Household Information (no print copy available)
Public Health Nursing - 263 Electronic File
EEPI-1
Infectious Disease Report (Communicable Disease Reporting Form)
Infectious Disease - 185
ECORE-1A
Client/Household Information Update
Public Health Nursing - 263 Electronic File
Electronic File
ED-1
Health Media Order Blank - Audiovisual Library
Audiovisual Library - 378
ECORE-3
Referral List/Long Term Problem List (no print copy available)
Public Health Nursing - 263 Electronic File
ECORE-4
Medical/Social History (no print copy available)
Public Health Nursing - 263 Electronic File
ECORE-4A
Diet History (no print copy available)
Public Health Nursing - 263 Electronic File
ECORE-5
Flow Sheet Immunizations (no print copy available)
Public Health Nursing - 263 Electronic File
ECORE-6
Medication Issued/Medication Orders (no print copy available)
Public Health Nursing - 263 Electronic File
ECORE-7
Progress Notes (no print copy available)
Public Health Nursing - 263 Electronic File
ECORE-8
Triage Note
Public Health Nursing - 263 Electronic File
ECH-15
Dietary Recall and Assessment for Children 10 to 20, 24 Hours
Health Promotion - 642
ECORE-10
Health Record Instructions (no print copy available)
Public Health Nursing - 263 Electronic File
Stock #4-25-lang Revised 10/25/2010
Electronic File
Electronic File
Page 51 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
CDC5279
(CDC 52.79) Cholera & Other Vibrio Illnesses (Vibriosis Surveillance Form)
Infectious Disease - 185
Electronic File
C-91
Diphtheria, Tetanus, and Pertussis-What You Need to Know
Immunization - 710
Forms
C-92
Measles, Mumps, and Rubella Vaccine-What You Need to Know (Limit 200)
Immunization - 710
Forms
C-94
Tetanus and Diphtheria-What You Need To Know
Immunization - 710
Forms
C-95
Hepatitis A Vaccine-What You Need to Know
Immunization - 710
Forms
C-96
Meningococcal Vaccine-What You Need to Know (Limit 200)
Immunization - 710
Forms
C-97
Chickenpox Vaccine-What You Need to Know (Limit 200)
Immunization - 710
Forms
CD-001
Drug Therapy for Treatment of Hansen's Disease
Hansen's Disease - 83
Forms
CH-4
Child Health Record, 7 - 12 Months
Texas Health Steps - 314
Forms
CDC525
(CDC 52.5) Typhoid Fever Surveillance Report (CDC)
Infectious Disease - 185
Electronic File
C-85
Pneumococcal Conjugate Vaccine-What You Need to Know (VIS)
Immunization - 710
Forms
CDC7354B
CDC73.54B Re-Interview Record
Warehouse
Forms
CDC7354C
CDC73.54C Cluster Interview Record
Warehouse
Forms
CDC7354D
CDC73.54D Visual Case Analysis Sheet
Warehouse
Forms
CDC73S
Field Record (Single) 73.2936S
Warehouse
Forms
CDC73W
CDC73.2936S Work Copy
Warehouse
Forms
CH-1
Child Health History
Texas Health Steps - 314
Forms
CH-2
Child Health Record, Birth -1 Month
Texas Health Steps - 314
Forms
CM-Intake
Non-medicaid Case Management Intake Form
Case Management - 309
Electronic File
CDC5042A
AIDS Case Report Form
HIV/STD - 44
Forms
C-110
Rotavirus Vaccine-Vaccine Information Statement (VIS) (Limit 200)
Immunization - 710
Forms
14-13277
Submitter Identification (ID) Number Request Form
Labs - 818
Forms
252-1
Business Information Form (Regulatory Services- Radiation)
Radiation Control - 326
Electronic File
25TAC601.8(1)
Disclosure and Consent for Hysterectomy
Health Facility Licensing 339
Forms
53-10880
How to Obtain Human Rabies Biologicals (Vaccine) from DSHS PHR 6/5S
HSR 6/5S-Zoonosis Control - 143
Forms
adop-court
Request for Identity of Court of Adoption
Vital Statistics - 71
Electronic File
B-21
Daily Report of Canteen Operations
Accounting-Cash Receipts - 598
Electronic File
C-105
Temperature Recording Form
Immunization - 710
Forms
C-106
Hepatitis B Vaccine-What You Need to Know (Limit 200)
Immunization - 710
Forms
C-90
Polio-What You Need to Know (IPV)
Immunization - 710
Forms
C-11
School/Daycare Immunization Record
Immunization - 710
Forms
C-86
Pneumococcal Polysaccaride Vaccine-What You Need to Know (VIS)
Immunization - 710
Forms
C-114
HPV (Human Papillomavirus Vaccine) (Gardasil)-What You Need to Know (VIS)
Immunization - 293
Forms
C-5
First Responder/Family Member Withdrawal of Consent and Confirmation Form
Immunization - 293
Forms
C-6
ImmTrac Provider Registration Form
Immunization - 293
Forms
C-68-Flu
TVFC-Influenza Vaccine Order Form
Immunization - 293
Forms
C-7
ImmTrac - DSHS Immunization Registry Consent Form
Immunization - 710
Forms
C-76
Vaccine Adverse Event Reporting System (VAERS)
Immunization - 710
Forms
Stock #4-25-lang Revised 10/25/2010
Page 52 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
C-8
Immunization Registry Withdrawal Form
Immunization - 293
CH-5
Child Health Record, 13 Months - 2 Years
Texas Health Steps - 314
Forms
C-108
Haemophilus Influenza Type B Vaccine-What You Need to Know
Immunization - 710
Forms
E107-12524
Contract Advisory Team-Review and Delegation (CATRAD) Form
Client Services Contract Unit - 774
Electronic File
DSHSIRBF100
Institutional Review Board Application Form
Center for Health Statistics - 551
Electronic File
DSHSIRBF101
Institutional Review Board Request for Exemption from Review of Research Form
Center for Health Statistics - 551
Electronic File
DSHSIRBF102
Institutional Review Board Request for Expedited Review of Research Form
Center for Health Statistics - 551
Electronic File
DSHSIRBF103
Institutional Review Board Final Report Upon Termination of Project Form
Center for Health Statistics - 551
Electronic File
DSHSIRBF105
Institutional Review Board Assent Document Guidelines
Center for Health Statistics - 551
Electronic File
DSHSIRBF1072
Institutional Review Board Consent Document Guidelines
Center for Health Statistics - 551
Electronic File
DSHSIRBF108
Institutional Review Board Consent Document Checklist
Center for Health Statistics - 551
Electronic File
CH-3
Child Health Record, 2 - 6 Months
Texas Health Steps - 314
Forms
E107-12523
Contract Advisory Team-Review and Delegation (CATRAD) Instructions
Client Services Contract Unit - 774
Electronic File
CPW-12
Case Management Authorization to Disclose Protected Health Information
Case Management - 309
Electronic File
E11-11443
Texas VFC-Provider Withdrawal Form
Immunization - 781
Electronic File
E13-06-11656
Dietary Recall and Assessment for Children 1 to 4, 24 Hours
Nutrition Services - 359
Electronic File
E13-11813
Texas HIV Medication Program Client Application
HIV/STD - 410
Electronic File
E13-11814
Texas HIV Medication Program Medical Eligibility Form
HIV/STD - 410
Electronic File
E14-13277
Submitter Identification (ID) Number Request Form
Labs - 819
Electronic File
E25TAC601.4(a)
Disclosure and Consent for Medical and Surgical Procedures
Health Facility Licensing 635
Electronic File
E25TAC601.5(1)
Disclosure and Consent for Radiation Therapy
Health Facility Licensing 635
Electronic File
E25TAC601.8(1)
Disclosure and Consent for Hysterectomy
Health Facility Licensing 635
Electronic File
DSHSIRBF109
Institutional Review Board Language Use Worksheet
Center for Health Statistics - 551
Electronic File
CPW-02A
Case Management Migrant Information Form
Case Management - 309
Electronic File
CH-6
Child Health Record, 3 - 5 Years
Texas Health Steps - 314
Forms
CH-7
Child Health Record, 6 - 10 Years
Texas Health Steps - 314
Forms
CIHCP Form 105
CIHCP Monthly Financial / Activity Report (County Indigent Health Care)
Indigent Health Program 421
Electronic File
CIHCP Form 106
Eligibility Dispute Resolution Request (County Indigent Health Care)
Indigent Health Program 421
Electronic File
EC-91
Diphtheria, Tetanus, and Pertussis-What You Need to Know (VIS)
Immunization - 781
Electronic File
CIHCP Form 500
Request for State Assistance Funds (County Indigent Health Care)
Indigent Health Program 421
Electronic File
EF05-12532
Women's Health Program Screening Form
Preventive & Primary Care - 678
Electronic File
CM-Pol
Case Management Policy Clarification Form
Case Management - 309
Electronic File
DSHS-EIA
Emergency Induced Abortion Certification Form
Vital Statistics - 346
Electronic File
Stock #4-25-lang Revised 10/25/2010
Forms
Page 53 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
CPW-02
Case Management Family Needs Assessment
Case Management - 309
Electronic File
DSHS-3TIA
Third Trimester Induced Abortion Certification Form
Vital Statistics - 346
Electronic File
CPW-04
Case Management Follow-up Form
Case Management - 309
Electronic File
CPW-04A
Case Management Follow-up Documentation Continued
Case Management - 309
Electronic File
CPW-05
Case Management Progress Notes
Case Management - 309
Electronic File
CPW-06
Prior Authorization Request for Additional Visits
Case Management - 309
Electronic File
CPW-06A
Request to Change Authorization to Another Case Manager
Case Management - 309
Electronic File
CPW-10
Case Management Notification Of Significant Provider Changes
Case Management - 309
Electronic File
CPW-11
Case Management Record Of CPW Billed Services
Case Management - 309
Electronic File
E59-11574
Invasive Streptococcal Disease Case Report
Infectious Disease - 185
Electronic File
CPW-01
CPW Initial Prior Authorization Request (formerly Case Management Intake/Enrollment)
Case Management - 309
Electronic File
EF23-12984
Salvage Establishments-Salvage Brokers-Initial, Renewal, or Change of Ownership (including legal
Food Licensing -146
Electronic File
EF21-13512
Promotor(a)/Community Health Worker Application for Certificate Renewal
Community Hlth Wrkr 371
Electronic File
EF23-12993
Certified Food Manager (CFM) Recertification - Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12992
Certified Food Manager (CFM) Recertification - Initial, Renewal
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12991
Certified Food Manager (CFM) Certification - Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12990
Certified Food Manager (CFM) Certification - Initial, Renewal, or Change of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12995
Certified Food Manager (CFM) Test Site - Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12987
Certified Food Manager (CFM) Certificate - Renewal/Replacement Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12996
Certified Food Manager (CFM) Examination Booklet Order Program Sites
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12983
Salvage Establishments-Salvage Brokers-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12981
Food Manufacturer-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12980
Food Warehouse Operator-Initial, Renewal, or Change of Ownership (including Legal entity)
Food Licensing -146
Electronic File
EF23-12979
Food Warehouse Operator-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12978
Food Wholesaler License-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12977
Food Wholesaler Registration-Initial, Renewal, or Change of Ownership (including legal entity)
Food Licensing -146
Electronic File
EF23-12989
Certified Food Manager (CFM) Food Handler Program - Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13003
Drug Distributor-Nonprescription Drugs License App-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13010
Multiple Products (Nonprescription Drugs-Food-Devices)-Initial, Renewal, or Change of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13009
Drug Manufacturer-Prescription Drugs License Application-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13008
Drug Manufacturer-Prescription Drugs License App-Initial, Renewal, or Change of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13007
Drug Manufacturer-Nonprescription Drugs License ApplicationMinor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 54 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
EF23-13006
Drug Manufacturer-Nonprescription Drugs License App-Initial, Renewal, or Chg of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12994
Certified Food Manager (CFM) Test Site - Initial Renewal
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13004
Drug Distributor-Prescription Drugs License App-Initial, Renewal, or Change of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12974
Retail Food Operation-Food Establishment-Food Store-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-13002
Drug Distributor-Nonprescription Drugs License App-Initial, Renewal, or Chg of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13001
Device Distributor-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13000
Device Manufacturer-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12999
Out-of-State Drug Distributor-Prescription Drugs License Application-Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12998
Certified Food Manager (CFM) Food Handler Program - Initial, Renewal
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12997
Certified Food Manager (CFM) Examination Booklet Order - Test Sites
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13005
Drug Distributor-Prescription Drugs License Application-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10603
Temporary Food Establishment Permit Application - 1 Event
Food Licensing -146
Electronic File
EF23-10853
Food Manufacturer License Application
Food Licensing -146
Electronic File
EF23-10621
Device Manufacturer License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10619
Body Piercing Studio License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10618
Tattoo Studio License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10613
Tanning Facilities License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12976
Food Wholesaler Registration-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-10609
Multiple Product Licenses Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10856
Drug Distributor (Manufacturer) License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10597
Retail Food Operation Permit Application
Food Licensing -146
Electronic File
EF23-10505
Food Wholesaler License Application
Food Licensing -146
Electronic File
EF23-10504
Salvage Establishment/Salvage Broker License Application (Food Salvage)
Food Licensing -146
Electronic File
EF21-13515
Training Program/Sponsoring Organization Application for Certificate Renewal
Community Hlth Wrkr 371
Electronic File
EF21-13514
Training Program/Sponsoring Organization Application for Certification
Community Hlth Wrkr 371
Electronic File
EF21-13513
Instructor Application for Certificate Renewal Promotor(a)/Community Health Worker
Community Hlth Wrkr 371
Electronic File
EF23-10611
Drug Distributor License Verification Affidavit
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12957
Certificate of Authority Minor Amendment (Drugs & Food Safety Licensing)
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13013
Multiple Products (Compressed Medical Gases-Nonprescr DrugFood-Devices)-Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12972
Food Establishment Inspection Application
Food Licensing -146
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 55 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
EF23-12971
Shellfish Processing Facility
Food Licensing -146
Electronic File
EF23-12970
Retail Temporary Food Establishment-Multiple Events
Food Licensing -146
Electronic File
EF23-12969
School Food Establishment Inspection Application
Food Licensing -146
Electronic File
EF23-12968
Crabmeat Processing Facility
Food Licensing -146
Electronic File
EF23-10854
Drug Distributor License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12958
Certificate of Authority (Drugs & Food Safety Licensing)
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10855
Drug Distributor License Applications For Out of State Firms
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12526
Order Form - Tanning Warning Signs
Drugs & Medical Device 675
Electronic File
EF23-10864
Salvage Establistment/Salvage Broker to Include Medical Devices License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10859
Childcare/School/Roadside Vendor/Mobile Unit Food Establishment Permit Application
Food Licensing -146
Electronic File
EF23-10858
Device Distributor License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10857
Bloodborne Pathogen Control Program Device Registration Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12975
Retail Food Operation-Childcare-School-Roadside Vendor-Mobile Food Vendor-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12967
Certificate of Freesale and Sanitation and/or Certificate of Origin
Food Licensing -146
Electronic File
EF59-10874
Antibiotic Resistant Isolate Reporting Form
Infectious Disease - 185
Electronic File
EF59-11354
Cholera and Other Vibrio Illness Surveillance Report (Vibriosis Reporting Form)
Infectious Disease - 185
Electronic File
EF59-11350
Meningitis (Bacterial) Disease Investigation Form (Bacterial Meningitis and Bacteremia Case Report)
Infectious Disease - 185
Electronic File
EF59-11347
Investigation of a Foodborne Outbreak Reporting Form
Infectious Disease - 185
Electronic File
EF59-11346
Escherichia coli 0157:H7 Food History Listing Form
Infectious Disease - 185
Electronic File
EF59-11345
Escherichia coli 0157:H7 and Hemolytic Uremic Syndrome Reporting Form
Infectious Disease - 185
Electronic File
EF49-11523
Hazardous Substance Registration Application Form
Reg Licensing - Hazardous Prod- 773
Electronic File
EF59-11343
Botulism--Foodborne Reporting Form
Infectious Disease - 185
Electronic File
EF60-12125
Athletic Trainer License Renewal Form
Advisory Board of Athletic Trainers - 207
Electronic File
EF59-10666
Contaminated Sharps Reporting Form
Infectious Disease - 185
Electronic File
EF49-11634
Electronic Filing Cover Sheet for the Texas Tier Two Report
Tier Two - 349
Electronic File
EF49-11630
Sample Training Roster (Model Employee Training Roster-Texas Hazard Communication Act)
Envir Hlth-PSQA - 55
Electronic File
EF49-11629
Tier Two Paperwork Reduction Form (PRF)
Tier Two - 349
Electronic File
EF49-11628
Tier Two Chemical Description Sheet
Tier Two - 349
Electronic File
EF23-13011
Multiple Products (Nonprescription Drugs-Food-Devices)-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF59-11344
Botulism--Infant Reporting Form
Infectious Disease - 185
Electronic File
EF62-13349
Application Cover Letter Form
Council on Sex Offender Treatment - 478
Electronic File
EF66-13412
Supervising Midwife/Apprentice Complaint Disclosure Form
Midwifery Program - 861
Electronic File
EF65-13344
Affidavit for Continuing Education Exemption (Medical Radiologic Technologist)
Stock #4-25-lang Revised 10/25/2010
Electronic File
Page 56 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
EF65-13332
Application for Limited Education Program
Medical Radiologic Techn. Certif Prog - 842
Electronic File
EF65-10711
Application for Hardship Exemption - Medical Radiologic Technologist
Medical Radiologic Techn. Certif Prog - 842
Electronic File
EF64-13397
Massage Therapy Educational Program Application for Basic 500Hour Program
Massage Therapy Program - 206
Electronic File
EF64-13389
Massage Therapy Instructor License Renewal Form
Massage Therapy Program - 206
Electronic File
EF59-11355
Yersiniosis Reporting Form
Infectious Disease - 185
Electronic File
EF64-13023
Continuing Education Provider Application/Agreement
Massage Therapy Program - 206
Electronic File
EF59-91102
Legionellosis Case Report (Legionnaires' Disease Reporting Form)
Infectious Disease - 185
Electronic File
EF62-13348
Supervison Form
Council on Sex Offender Treatment - 478
Electronic File
EF62-13347
Contract of Supervision for ASOTP or PSOTP
Council on Sex Offender Treatment - 478
Electronic File
EF61-10684
Application for Contact Lens Disp Permit - Individual or Sole Proprietor
Contact Lens Dispensing Permit Program - 164
Electronic File
EF61-10683
Application for Contact Lens Dispensing Permit - Corporation or Other Business Entity
Contact Lens Dispensing Permit Program - 164
Electronic File
EF60-13340
Athletic Trainer Application Packet
Advisory Board of Athletic Trainers - 207
Electronic File
EF47-10629
Grade "A" Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
EF64-13388
Massage Therapy License Renewal Form
Massage Therapy Program - 206
Electronic File
EF23-13019
Retail Raw Dairy
Drugs & Food Safety Licensing - 89
Electronic File
EF25-11006
Annual Survey of Hospitals
Center for Health Statistics - 397
Electronic File
EF23-13368
In-State Non Grade "A" Dairy Products Processor
Drugs & Food Safety Licensing - 89
Electronic File
EF67-10722
Opticians Registry - Application for Optician Registration
Optician's Registry Program - 502
Electronic File
EF23-13281
Model Form 1-A Conditional Employee and Food Employee Interview
Food Establishments - 811
Electronic File
EF23-13022
Tattoo-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF49-11627
Tier Two Cover Sheet
Tier Two - 349
Electronic File
EF23-13020
Transfer and/or Receiving Station
Drugs & Food Safety Licensing - 89
Electronic File
EF29-12374
Certification Regarding Lobbying Certification for Contracts, Grants, Loans & Cooperative Agreements
Client Services Contracting - 701
Electronic File
EF23-13018
Producer Dairy
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13017
Body Piercing Studio-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13016
Out-of-State Drug Distributor-Prescription Drugs License Application-Initial, Renewal
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13015
Out-of-State Drug Distributor-Non-Prescription Drugs License Application-Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13014
Out-of-State Drug Distributor-Non-Prescription Drugs License Application-Initial, Renewal
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12982
Bottled Water Operators Certificate of Competency Exam Application
Food Licensing -146
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 57 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF23-13021
Tanning Facilities-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF41-10982
KHC Contracted Dialysis Provider Information Form
Kidney Health Care - 180
Electronic File
EF47-10628
Out-of-State Milk or Dairy Products Processor Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
EF47-10627
Out-of-State Frozen Dessert Manufacturer Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
EF47-10626
In-State Milk or Dairy Products Processor Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
EF47-10625
In-State Frozen Dessert Manufacturer Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
EF47-10624
Milk Tank Truck Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
EF45-13284
Diabetes Mellitus Registry Pilot Program Consent Form
Texas Diabetes Council 831
Electronic File
EF25-11047
Annual Statement of Community Benefits Standard
Center for Health Statistics - 476
Electronic File
EF41-11811
Hemophilia Assistance Program - Application for Assistance (Adults over 21)
Hemophilia Assistance 404
Electronic File
EF25-12466
Research Data Dictionary; Research Data Use Agreement; Research Data Request Form
Tx Hlth Care Info Collection - 407
Electronic File
EF41-10981
KHC Non-Contracted Dialysis Provider Information Form
Kidney Health Care - 180
Electronic File
EF32-12269
Records Retention Schedule Amendment
Records Management - 204 Electronic File
EF32-12236
Destruction/Disposition of Records (Disposition Log adopted by HHS Enterprise)
Records Management - 204 Electronic File
EF32-11043
Model Release Form
Web Technology Services - 392
EF32-10521
Statement of Responsibility Form - Audiovisual Library
Audiovisual Library - 378
Electronic File
EF23-13012
Multiple Products (Compressed Medical Gases-Nonprescr Drug)Initial, Renewal, or Change of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
EF41-12836
KHC Prescription Drug Plan Provider Enrollment Form
Kidney Health Care - 180
Electronic File
EF18-12249
Company Name Change (Environmental & Sanitation LicensingMold)
PSQA-Envir Hazards - 365
Electronic File
EF105-12316
Symptom and Side Effects Monitoring Sheet: Schizophrenia
TIMA-Patient/Family Ed 586
Electronic File
EF18-12058
Mold Training Instructor Reference Form
PSQA-Envir Hazards - 365
Electronic File
EF11-13286
Screening Questionaire for Intranasal 2009 H1N1 Influenza Vaccine
Immunization - 832
Electronic File
EF10-12888
2008 MPH Training Registration Form
Cancer Epi/Surv - 742
Electronic File
EF18-12082
Business Information Form (Asbestos Program)
Asbestos Program - 361
Electronic File
EF12-12062
Contact Investigation Worksheet (temporarily unavailable)
Infectious Disease Control Unit - TB - 320
Electronic File
EF20-11979
Youth Camp & Day Camp Application
Environ/Consumer Safety 616
Electronic File
EF10-11698
Request for Confidential Cancer Registry Data
Cancer Epi/Surv - 369
Forms
EF12-12870
Correctional Tuberculosis Program Symptom Screening
Infectious Disease Control Unit - TB - 320
Electronic File
EF18-12283
AHERA Compliance Inspection Checklist
PSQA-Asbestos - 573
Electronic File
EF19-11465
Application to Participate in Fund-Raising Activities
Off. of Gen. Counsel - 43
Electronic File
EF12-12104
TB Incident Report
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-12478
Mycobacterium tuberculosis Genotyping Request Form
Infectious Disease Control Unit - TB - 320
Electronic File
Stock #4-25-lang Revised 10/25/2010
Electronic File
Page 58 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF12-11358
Binational Status Report (TB)
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-12105
PPD Agreement for Texas Health Steps Providers
Infectious Disease Control Unit - TB - 320
Electronic File
EF17-12576
Lead Abatement Notification Form
Envir Hlth Group - 690
Electronic File
EF18-12144
Mold Remediation Notification Form
PSQA-Envir Hazards - 365
Electronic File
EF11-13502
ImmTrac No Provider Withdrawal Form
Immunization - 888
Electronic File
EF12-11461
Positive PPD/Suspects and/or Cases
Infectious Disease Control Unit - TB - 320
Electronic File
EF13-06-12805
VENA Family Documentation Form (restricted to Texas WIC Local Agencies)
Nutrition Services - 730
Electronic File
EF12-11051
Hand Screen Record - Hansen's Disease
Infectious Disease - 629
Electronic File
EF13-06-13152
Texas WIC Medical Request for Formula/Food
Nutrition Services - 669
Electronic File
EF13-06-13158
Texas WIC Metabolic Request for Formula/Food
Nutrition Services - 669
Electronic File
EF13-06-13184
Texas Ten Step Applications
Nutrition Services - 809
Electronic File
EF12-11050
Foot Screen Record - Hansen's Disease
Infectious Disease - 629
Electronic File
EF18-12048
Mold Licensing Program Complaint Form
PSQA-Envir Hazards - 365
Electronic File
EF14-13230
Use and Storage of Newborn Screening Bloodspot Cards (Directive to Destroy)
Labs - 819
Electronic File
EF11-13500
ImmTrac Site Agreement and Confidentiality Statement Update/Renewal Form
Immunization - 887
Electronic File
EF12-13458
Report/Request for TB Supplies
Infectious Disease Control Unit - TB - 320
Forms
EF12-11462
Monthly Correctional TB Report
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-13204
Texas Refugee Health Assessment Form
Refugee Health - 815
Electronic File
EF11-13501
ImmTrac Provider Withdrawal Form
Immunization - 888
Electronic File
EF105-12317
Symptom and Side Effects Monitoring Sheet- Depression
TIMA-Patient/Family Ed 586
Electronic File
EF12-11494
TB Questionnaire (English)
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-12274
Report of Serious Adverse Drug Reaction Resulting in Hospitalization or Death
Infectious Disease Control Unit - TB - 320
Electronic File
EF14-03252
Newborn Screening Supplies Order Form
Labs - 578
Electronic File
EF07-12272
Personal Emergency Response System (PERS) Providers Certificate of Proof of Liability Insurance
PERS Providers - 568
Electronic File
EF07-13429
Client Drug Co-Pay Reimbursement Request Form/Solicitud del cliente para el reembolso del copago
Children w/Special Health Care Needs - 692
Electronic File
EF11-10866
Acute Hepatitis B Case Track Record
Infectious Disease - 727
Electronic File
EF20-12376
Youth Camp Training Program Application
Environ/Consumer Safety 616
Electronic File
EF21-13510
Promotor(a)/Community Health Worker Application for Certification
Community Hlth Wrkr 371
Electronic File
EF21-12032
Title V POP Program Performance Report (Quarterly/Annual Report)
Title V - 461
Electronic File
EF11-11406
Authorization to Release ImmTrac History Form
Immunization - 887
Electronic File
EF11-10869
Mumps Case Track Record
Infectious Disease - 727
Electronic File
EF107-12790
Board Training Course Report Form
Contract Oversight/Support - 762
Electronic File
EF21-12003
Title V Population-Based Monthly Report
Title V - 461
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 59 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF21-12004
Monthly Reimbursement Request - Primary Care or Population Based (Title V)
Title V - 461
Electronic File
EF21-12005
Monthly Reimbursement Request for Title V MCH Fee for Service Program
Title V - 461
Electronic File
EF21-12006
PHR Summary Report of Contractor Program Performance (Title V)
Title V - 461
Electronic File
EF11-10871
Haemophilus Influenzae Case Track Record
Infectious Disease - 727
Electronic File
EF11-12221
Japanese Encephalitis Vaccine-What You need to Know - Vaccine Information Statement (VIS)
Immunization - 41
Electronic File
EF21-12007
Program Revision (Title V)
Title V - 461
Electronic File
EF11-13285
Screening Questionaire for Injectable 2009 H1N1 Influenza Vaccine
Immunization - 832
Electronic File
EF20-12909
Self Certification Info Packet (Facility Licensing)
Facility Licensing - 752
Electronic File
EF20-12910
Plan Review Application (Facility Licensing)
Facility Licensing - 752
Electronic File
EF20-12911
Inspection Application (Facility Licensing)
Facility Licensing - 752
Electronic File
EF20-12912
Final Construction Approval Form (Facility Licensing)
Facility Licensing - 752
Electronic File
EF21-11809
Eligibility Determination (Title V)
Title V - 461
Electronic File
EF21-13511
Instructor Application for Certification - Promotor(a)/Community Health Worker
Community Hlth Wrkr 371
Electronic File
EF09-11624
Adult Blood Lead Reporting Form
Blood Lead Epi - 863
Electronic File
EF12-12168
Monthly Tuberculin Skin Testing Form
Infectious Disease Control Unit - TB - 320
Electronic File
EF107-12927
Board Responsibilities Attestation Form
Contract Oversight/Support - 762
Electronic File
EF11-12955
Immunization Registry (ImmTrac) First Responder/Family Member Request Form
Immunization - 887
Electronic File
EF09-11709
Childhood Blood Lead Level Report Form
Childhood Lead Poisoning - 385
Electronic File
EF105-12318
Symptom and Side Effects Monitoring Sheet-Bipolar Disorder (Mania)
TIMA-Patient/Family Ed 586
Electronic File
EF21-11817
Presumptive Eligilibility (Title V)
Title V - 461
Electronic File
EF11-12887
Uniform Stamp Replacement Form (Yellow Fever)
Immunization - 741
Electronic File
EF11-10867
Tetanus Case Track Record
Infectious Disease - 727
Electronic File
EF09-11927
Human Pesticide Exposure Report Form
Pesticide Exposure Surv (PEST) - 452
Electronic File
Forms-Building Services / Formularios--servicios de apoyo para los edificios EF27-11199
Space Request Form
Executive & Staff Operations - 39
Electronic File
Forms-Contract / Formularios--contratos EF29-12374
Certification Regarding Lobbying Certification for Contracts, Grants, Loans & Cooperative Agreements
Client Services Contracting - 701
Electronic File
EF29-12414
Contract Revision Request
Client Services Contract Unit - 774
Electronic File
GC-11
Nonexpendable Personal Property
Contract Oversight/Support - 592
Forms
GC-10
Request for Advance or Reimbursement (270)
Warehouse
Forms
F04-12310
Policy Clarification Form (Community Health Services)
Community Hlth Svs - 582
Forms
EHCFA-1513
Disclosure of Ownership and Control Interest Statement
Client Services Contract Unit - 774
Electronic File
EGC-4A
Financial Status Report (269a)
Accounting-Claims - 660
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 60 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E107-12524
Contract Advisory Team-Review and Delegation (CATRAD) Form
Client Services Contract Unit - 774
Electronic File
EGC-10
Request for Advance or Reimbursement (270)
Accounting-Claims - 660
Electronic File
EF04-12310
Policy Clarification Form (Community Health Services)
Community Hlth Svs - 581
Electronic File
E107-12523
Contract Advisory Team-Review and Delegation (CATRAD) Instructions
Client Services Contract Unit - 774
Electronic File
EGC-11
Nonexpendable Personal Property
Contract Oversight/Support - 591
Electronic File
Forms-Eligibility / Formularios--elegibilidad EDEDP-1
Diabetic Eye Disease Program Sample Patient Tracking Form
Texas Diabetes Council 438
Electronic File
EF12-12105
PPD Agreement for Texas Health Steps Providers
Infectious Disease Control Unit - TB - 320
Electronic File
EF10-11698
Request for Confidential Cancer Registry Data
Cancer Epi/Surv - 369
Forms
EF05-11770
Application for Formula Assistance
Newborn Screening - 281
Electronic File
EF01-11816
Emergency Care Attendant Training Request
EMS- 411
Electronic File
EDEDP-6
Diabetic Eye Disease Program Request for Tracking Forms
Texas Diabetes Council 438
Electronic File
KHP-1
Kidney Health Care-Application for Benefits & Instruction
Kidney Health Care - 179
Forms
EDEDP-2
Diabetic Eye Disease Program Nominator Application
Texas Diabetes Council 438
Electronic File
F41-11839
Hemophilia Assistance Program-Covered Products, Allowable Fees, Limitations & Requirements
Hemophilia Assistance 403
Forms
E13-11814
Texas HIV Medication Program Medical Eligibility Form
HIV/STD - 410
Electronic File
E13-11813
Texas HIV Medication Program Client Application
HIV/STD - 410
Electronic File
DEDP 6
Diabetic Eye Disease Program Request for Tracking Forms
Texas Diabetes Council 305
Forms
DEDP 4
Diabetic Eye Disease Program Agreement Between Eye Care Provider and Dept of State Heath Services
Texas Diabetes Council 305
Forms
DEDP 2
Diabetic Eye Disease Program Nominator Application
Texas Diabetes Council 305
Forms
DEDP 1
Diabetic Eye Disease Program Sample Patient Tracking Form
Texas Diabetes Council 305
Forms
EDEDP-4
Diabetic Eye Disease Program Agreement Between Eye Care Provider and Texas Dept of Heath
Texas Diabetes Council 438
Electronic File
EF13-06-12805
VENA Family Documentation Form (restricted to Texas WIC Local Agencies)
Nutrition Services - 730
Electronic File
EKHP-1
Kidney Health Care-Application for Benefits
Kidney Health Care - 180
Electronic File
EF41-11839
Hemophilia Assistance Program-Covered Products, Allowable Fees, Limitations & Requirements
Hemophilia Assistance 404
Electronic File
EF41-11838
Hemophilia Assistance Program - Fact Sheet
Hemophilia Assistance 404
Electronic File
EF41-11811
Hemophilia Assistance Program - Application for Assistance (Adults over 21)
Hemophilia Assistance 404
Electronic File
EF21-11845
Notice of Eligibliity (Title V/PHC Contract Programs)
Title V - 461
Electronic File
EF21-11844
Screening Document for Medical Services Assistance
Title V - 461
Electronic File
WIC-35
Family Certification Form (Replaced WIC-19)
Nutrition Services - 885
Forms
EF21-11809
Eligibility Determination (Title V)
Title V - 461
Electronic File
EWIC-35
Family Certification Form (Replaced WIC-19)
Nutrition Services - 401
Electronic File
WIC Supplemental Information Form
Nutrition Services - 401
Electronic File
EWIC-35-1
Stock #4-25-lang Revised 10/25/2010
Page 61 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EWIC-35-3
WIC Income Questionnaire
Nutrition Services - 401
Electronic File
WIC-35-1
WIC Supplemental Information Form
Nutrition Services - 885
Forms
F05-11770
Application for Formula Assistance (Limit 5)
Newborn Screening - 136
Forms
F13-06-12805
VENA Family Documentation Form (restricted to Texas WIC Local Agencies)
F41-11811
Hemophilia Assistance Program - Application for Assistance (Adults over 21)
Hemophilia Assistance 403
Forms
F41-11838
Hemophilia Assistance Program - Fact Sheet
Hemophilia Assistance 403
Forms
EF21-11817
Presumptive Eligilibility (Title V)
Title V - 461
Electronic File
Forms
Forms-Fiscal or Accounting / Formularios--fiscales o de contabilidad F29-12280
Pro Rata Tobacco Settlement Distribution County Expenditure Statement
Funds Coordination - 571
Forms
EF29-12559
Bank and Petty Cash Fund Reconcilliation Form
Accounting-General Ledger - 94
Electronic File
EF29-12390
CSCU - Contract Budget / Revised Budget
Client Services Contracting - 701
Electronic File
EF29-12391
CSCU - Vendor Information Form
Client Services Contracting - 701
Electronic File
EF29-12392
CSCU - Security Access Form - Contract Development System (CDS)
Client Services Contracting - 617
Electronic File
EF29-12393
Professional Services Contract
Client Services Contracting - 617
Electronic File
EF29-12394
DSHS Request for Contract Development
Client Services Contracting - 617
Electronic File
EF29-12395
Contract Initiation / Modification Document
Client Services Contracting - 617
Electronic File
EF29-12397
Emergency / Sole Source Justification Request Form
Client Services Contracting - 617
Electronic File
EF29-12414
Contract Revision Request
Client Services Contract Unit - 774
Electronic File
EF29-12389
DSHS - Child Support Certification
Client Services Contracting - 701
Electronic File
EF29-12503
Vendor Direct Deposit Authorization Form
Claims Processing - 599
Electronic File
TrvlVchr-
Travel Voucher
Travel Office - 333
Electronic File
EF29-12609
Travel Request for Non-employees
Claims Processing - 599
Electronic File
EF30-12086
Travel Request Authorization Form
Travel Office - 333
Electronic File
EF39-11705
Budget Certification and Salary Changes (includes request for a new FTE)
Budget - 619
Electronic File
EF39-11707
Request to Utilize Salary Savings
Budget - 619
Electronic File
EHCFA-1513
Disclosure of Ownership and Control Interest Statement
Client Services Contract Unit - 774
Electronic File
F29-12279
Pro Rata Tobacco Settlement Distribution Hospital District Hospital Expenditure Statement
Funds Coordination - 571
Forms
USER-AGREE
JPMorganChase User Agreement (Travel Card)
Travel Office - 333
Electronic File
F29-12278
Pro Rata Tobacco Settlement Distribution Non-Hospital District Public Hospital Expenditure Statement
Funds Coordination - 571
Forms
EF29-12476
Multiple PO Close Out Form
Accounting-Claims Processing - 700
Electronic File
EB-13A
Supporting Schedule for Contracts Requiring Match
Accounting-Claims - 660
Electronic File
B-17
Interagency Voucher Detail (Interagency Transaction Voucher-ITV)
Warehouse
Forms
Stock #4-25-lang Revised 10/25/2010
Page 62 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
B-21
Daily Report of Canteen Operations
Accounting-Cash Receipts - 598
Electronic File
EF29-12280
Pro Rata Tobacco Settlement Distribution County Expenditure Statement
Funds Coordination - 572
Electronic File
EB-13
State of Texas Purchase Voucher
Accounting-Claims - 660
Electronic File
EB-13X
Supporting Schedule for Title X Reimbursement Voucher
Accounting-Claims - 660
Electronic File
EB-15
Multi-Vendor Voucher Cover
Travel Office - 333
Electronic File
EB-19
Travel to Agency Sponsored Seminar
Travel Office - 333
Electronic File
EB-71
Multiple Activity Travel Report
Travel Office - 333
Electronic File
EF104-12211
Request for Unencumbered Payment of Registration Fees
Claims Processing - 599
Electronic File
EAPP-FORM
JPMorganChase (Individual Bill) Cardholder Account Application
Travel Office - 333
Electronic File
EF29-12278
Pro Rata Tobacco Settlement Distribution Non-Hospital District Public Hospital Expenditure Statement
Funds Coordination - 572
Electronic File
EF29-11961
Nonprofit Board of Directors and Executive Director Assurances Form
Client Services Contracting - 701
Electronic File
EF29-11931
Grant Action Tracking Tool (GATT)
Funds Coordination & Mgmt - 265
Electronic File
EF107-12500
Determination of Vendor or Subrecipient Status
Contract Oversight/Support - 707
Electronic File
EF29-12279
Pro Rata Tobacco Settlement Distribution Hospital District Hospital Expenditure Statement
Funds Coordination - 572
Electronic File
Information Systems - 473
Electronic File
Forms-Human Resources / Formularios--recursos humanos EAP-111
Computer Usage Agreement
Forms-Inspection / Formularios--inspecciones IR-CROSS
Industrial Radiography Records Cross Check
Radiation Control - 326
Electronic File
IR-TR
Industrial Radiography Training Worksheet
Radiation Control - 326
Electronic File
CI-38
Confirmation of Scheduled Inspection with Special Instructions and Checklist
Radiation Control - 326
Electronic File
F18-12283
AHERA Compliance Inspection Checklist
Asbestos - 607
Forms
F18-12164
Mold - Notice of Inspection
PSQA-Envir Hazards - 405
Forms
F18-11429
Site Inspection Checklist/NESHAP & TAHPA
Asbestos - 607
Forms
EH-17
Renovation/New Construction Inspection Checklist
Inspection Unit - 825
Forms
EF20-12911
Inspection Application (Facility Licensing)
Facility Licensing - 752
Electronic File
EF18-12283
AHERA Compliance Inspection Checklist
PSQA-Asbestos - 573
Electronic File
EF20-11587
Youth Camp Inspection Form
Environ/Consumer Safety 616
Electronic File
Off. of Gen. Counsel - 43
Electronic File
Electronic File
Forms-Legal / Formularios--legales EF19-11169
Registration of Representation Before Texas Department of State Health Services (Visitor Sign-in)
Forms-Library / Formularios--biblioteca EF32-10544
Request for Publication Number Form
Publications Management Program - 86
EF32-12269
Records Retention Schedule Amendment
Records Management - 204 Electronic File
ETSL-101
Transmittal of State Records
Records Management - 204 Electronic File
EF32-10521
Statement of Responsibility Form - Audiovisual Library
Audiovisual Library - 378
Electronic File
ED-1
Health Media Order Blank - Audiovisual Library
Audiovisual Library - 378
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 63 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Forms-Licensing / Formularios--autorizacion Medical Radiologic Techn. Certif Prog - 842
Electronic File
EF65-13332
Application for Limited Education Program
EF65-13344
Affidavit for Continuing Education Exemption (Medical Radiologic Technologist)
EF66-10717
Midwife Informed Choice and Disclosure Statement
Midwifery Program - 671
Electronic File
EF66-13412
Supervising Midwife/Apprentice Complaint Disclosure Form
Midwifery Program - 861
Electronic File
EF65-10711
Application for Hardship Exemption - Medical Radiologic Technologist
Medical Radiologic Techn. Certif Prog - 842
Electronic File
EF67-10722
Opticians Registry - Application for Optician Registration
Optician's Registry Program - 502
Electronic File
EF67-12090
Statement of Continuing Education Form for Opticians
Optician's Registry Program - 502
Electronic File
EF73-12964
Form VI-Supervised Clinical Practicum Supervision and Experience Verification Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF68-13333
Practioner of Respiratory Care State Certification/Registration Verification Form
Respiratory Care Pract. Certif. Program - 843
Electronic File
EF69-11751
Hearing Instrument Fitters and Dispensers Complaint Reporting Form
St. Comm. Examrs. In Fit & Disp. Hear Instr - 279
Electronic File
EF69-11967
Application for Continuing Education Program Approval - Fitting & Disp of Hearing Instruments
St. Comm. Examrs. In Fit & Disp. Hear Instr - 279
Electronic File
EF69-13300
Application Form Temporary Training Permit
St. Comm. Examrs. In Fit & Disp. Hear Instr - 279
Electronic File
EF64-13397
Massage Therapy Educational Program Application for Basic 500Hour Program
Massage Therapy Program - 206
Electronic File
EF73-12433
MFT CE Provider Approval Application/Renewal Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-12965
Form VII-Examination Security Information Acknowledgement Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF47-10625
In-State Frozen Dessert Manufacturer Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
EF73-12963
Form B-Continuing Education Provider Approval Application/Renewal (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 460
Forms
EF64-13023
Continuing Education Provider Application/Agreement
Massage Therapy Program - 206
Electronic File
EF73-12961
Form IV-Probation/Monitoring Supervision Plan (for licensees under board ordered supervision)
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-12962
Form B-Texas State Board of Marriage and Family Therapists Renewal Application Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-12959
Form I-Course Equivalency Request (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF69-13399
Application for Continuing Education Sponsor (Hearing Instruments)
St. Comm. Examrs. In Fit & Disp. Hear Instr - 279
Electronic File
EF73-10753
Tx St Bd of Examiners of Marriage and Family Therapists Supervisory Agreement Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-10752
Tx St Bd of Examiners of Marriage and Family Therapists Supervisor Application
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
Stock #4-25-lang Revised 10/25/2010
Electronic File
Page 64 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
EF73-10751
Tx St Bd of Examiners of Marriage & Family Therapists -Supervised Experience Doc Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-10748
Texas State Board of Examiners of Marriage & Family Therapists Application Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF72-12124
Dietitian Renewal Form
Tx State Bd of Examiners of Dietitians - 508
Electronic File
EF72-10745
Dietitian Application for Licensure
Tx State Bd of Examiners of Dietitians - 508
Electronic File
EF73-12960
Form II-Verification of Licensure in Other Jurisdiction (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF47-10626
In-State Milk or Dairy Products Processor Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13012
Multiple Products (Compressed Medical Gases-Nonprescr Drug)Initial, Renewal, or Change of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13013
Multiple Products (Compressed Medical Gases-Nonprescr DrugFood-Devices)-Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13014
Out-of-State Drug Distributor-Non-Prescription Drugs License Application-Initial, Renewal
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13015
Out-of-State Drug Distributor-Non-Prescription Drugs License Application-Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF75-10962
St Bd of Exam of Prof Counselors-Practicum Documentation
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF82-12008
Request for Retired Professional Sanitarian Exemption Form
Registered Sanitarian - 242
Electronic File
EF23-13017
Body Piercing Studio-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13018
Producer Dairy
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13019
Retail Raw Dairy
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13020
Transfer and/or Receiving Station
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13021
Tanning Facilities-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13022
Tattoo-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF47-10627
Out-of-State Frozen Dessert Manufacturer Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
EF47-10624
Milk Tank Truck Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
EF62-13349
Application Cover Letter Form
Council on Sex Offender Treatment - 478
Electronic File
EF23-13016
Out-of-State Drug Distributor-Prescription Drugs License Application-Initial, Renewal
Drugs & Food Safety Licensing - 89
Electronic File
EF47-10628
Out-of-State Milk or Dairy Products Processor Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
EF47-10629
Grade "A" Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
EF49-11290
Application for Volatile Chemical Sales Permit
Abusive Volatile Chemicals Program - 192
Electronic File
EF49-11523
Hazardous Substance Registration Application Form
Reg Licensing - Hazardous Prod- 773
Electronic File
EF49-11742
Bedding License Application
Chem & Prod Sfty(Bedding) - 772
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 65 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF49-12097
Germicidal Treatment Application Packet
Chem & Prod Sfty(Bedding) - 772
Electronic File
EF60-12125
Athletic Trainer License Renewal Form
Advisory Board of Athletic Trainers - 207
Electronic File
EF60-13340
Athletic Trainer Application Packet
Advisory Board of Athletic Trainers - 207
Electronic File
EF61-10683
Application for Contact Lens Dispensing Permit - Corporation or Other Business Entity
Contact Lens Dispensing Permit Program - 164
Electronic File
EF61-10684
Application for Contact Lens Disp Permit - Individual or Sole Proprietor
Contact Lens Dispensing Permit Program - 164
Electronic File
EF62-13347
Contract of Supervision for ASOTP or PSOTP
Council on Sex Offender Treatment - 478
Electronic File
EF62-13348
Supervison Form
Council on Sex Offender Treatment - 478
Electronic File
EF23-13368
In-State Non Grade "A" Dairy Products Processor
Drugs & Food Safety Licensing - 89
Electronic File
F02-13364
Licensed Chemical Dependency Counselor Intern Clinical Training Institution (CTI) Assessment Form
Licensed Chemical Dependency Counselor 534
Forms
EF82-11543
Sanitarian Application for Registration
Registered Sanitarian - 242
Electronic File
F18-11667
Asbestos Application Individual Name Change
Asbestos - 148
Forms
F18-11665
Asbestos License New/Renewal Training Provider
Asbestos - 148
Forms
F18-11664
State Accreditation Examination Registration Form (Asbestos Program)
Asbestos - 148
Forms
F17-12576
Lead Notification Form
Envir Hlth Group - 689
Forms
F18-11669
Physician's Written Statement (Asbestos Program)
Asbestos - 148
Forms
F02-13440
Application for Licensure Dyslexia Therapist or Dyslexia Practitioners
Dyslexia Therapist - 876
Forms
F18-11670
Asbestos Operations & Maintenance Contractor (Restricted) License Application
Asbestos - 148
Forms
F02-12273
Personal Emergency Response System (PERS) Providers Application for Registration
PERS Providers - 567
Forms
F02-12272
Personal Emergency Response System (PERS) Providers Certificate of Proof of Liability Insurance
PERS Providers - 567
Forms
F02-12271
Personal Emergency Response System (PERS) Providers Application for License
PERS Providers - 567
Forms
F01-13072
EMS Provider License Notification/Changes
EMS - 791
Forms
F01-13071
EMS Provider-Medical Director Information Form
EMS - 791
Forms
F01-13070
EMS Provider Vehicle Form
EMS - 791
Forms
F05-02361
Spinal Screening Certification Card
Vision, Hearing and Spinal Screening - 276
Forms
F18-11677
Asbestos Application/Renewal Individual Asbestos Consultant
Asbestos - 148
Forms
F18-11691
Application for Asbestos Agency Duplicate License/Registration
Asbestos - 148
Forms
F18-11683
Asbestos Transporter License Application
Asbestos - 148
Forms
F18-11682
Asbestos Laboratory License Application
Asbestos - 148
Forms
F18-11681
Asbestos Application/Renewal Air Monitor Technician
Asbestos - 148
Forms
F18-11680
Asbestos License Application/Renewal Project Manager
Asbestos - 148
Forms
F18-11668
Asbestos Application Individual Duplicate
Asbestos - 148
Forms
F18-11678
Asbestos Management Planner Agency License Application
Asbestos - 148
Forms
F01-13067
EMS Provider License Application
EMS - 791
Forms
Stock #4-25-lang Revised 10/25/2010
Page 66 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F18-11676
Asbestos Application/Renewal Asbestos Inspector
Asbestos - 148
Forms
F18-11675
Asbestos Consultant Agency License Application
Asbestos - 148
Forms
F18-11674
Asbestos License Application/Renewal Abatement Supervisor
Asbestos - 148
Forms
F18-11673
Asbestos License Application/Renewal Asbestos Worker
Asbestos - 148
Forms
F18-11672
Asbestos Contractor License Application
Asbestos - 148
Forms
F18-11671
Asbestos License Application/Renewal Operations & Maintenance Supervisor
Asbestos - 148
Forms
F18-11679
Asbestos Application/Renewal Individual Management Planner
Asbestos - 148
Forms
EF76-11925
Renewal Form for Web site (State Board of Examin for Speech/Audiology)
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF77-11660
St Bd of Social Worker Exam-Social Work License Renewal Form
Tx State Bd of Social Worker Examiners - 358
Electronic File
EF77-11659
St Bd of Social Worker Exam-Application to be a Supervisor
Tx State Bd of Social Worker Examiners - 358
Electronic File
EF77-10801
ACP/AP Supervision Forms Packet (Texas State Board of Social Worker Examiners)
Tx State Bd of Social Worker Examiners - 358
Electronic File
EF76-13408
Alternate Supervision of an Assistant Request Plan
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF76-12586
Application to Upgrade Intern License to Full Licensure
State Bd of Exam of Speech & Audiology - 213
Electronic File
F01-13069
EMS Provider License-Personnel
EMS - 791
Forms
EF76-12381
Exception Request to Supervising with Less Than Three Years Experience (Speech-Language Pathology)
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF77-11663
St Bd of Social Worker Exam-Supervision Verification for Adv Clinical Practitioner/Adv Pra (ACP/AP)
Tx State Bd of Social Worker Examiners - 358
Electronic File
EF75-13407
Verification of Licensure in Other Jurisdiction (Professional Counselor)
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF75-13346
LPC Application Packet
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF75-13345
Course Evaluation / Licensing Information Sheet
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF75-10967
St Bd of Exam of Prof CounselorsSupervisory Agreement Form
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF75-10966
St Bd of Exam of Prof Counselors-Supervisor Application Form
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF75-10963
St Bd of Exam of Prof Counselors-Supervised Experience Documentation Form
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF76-12382
Exception Request to Supervising More than Four Interns/Assistants (Speech-Language Pathology)
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF23-13011
Multiple Products (Nonprescription Drugs-Food-Devices)-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF75-10781
St Bd of Examiners of Prof Counselors-Pre-Approved Cont Educ Prov Appl
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
F01-13066
EMS Provider License Declaration Form
EMS - 791
Forms
F01-13065
EMS Provider License Certificate / Vehicle Authorization Replacement Request
EMS - 791
Forms
EH-19
Deficiency Notice
Warehouse
Forms
EF82-12232
Professional Sanitarian Renewal Form
Registered Sanitarian - 242
Electronic File
EF82-12231
Code Enforcement Officer Renewal Form
Code Enforcement Officers - 219
Electronic File
EF77-11661
St Bd of Social Worker Exam-Supervision Plan
Tx State Bd of Social Worker Examiners - 358
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 67 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF82-11947
Commercial Education Business Continuing Education Provider Application/Agreement (Prof Sanitarian)
Registered Sanitarian - 242
Electronic File
EF77-11662
St Bd of Social Worker Exam-Supervision Verification for SWA (Social Worker Associate)
Tx State Bd of Social Worker Examiners - 358
Electronic File
EF77-13402
Board-Ordered Supervision Plan (Form IX)
Tx State Bd of Social Worker Examiners - 857
Electronic File
EF77-13401
Non-Clinical Supervision Plan (Form IV)
Tx State Bd of Social Worker Examiners - 857
Electronic File
EF77-13400
Clinical Supervision Plan (Form III)
Tx State Bd of Social Worker Examiners - 857
Electronic File
EF77-13336
Form V-Clinical Supervision Verification for LCSW
Tx State Bd of Social Worker Examiners - 845
Electronic File
EF77-13303
Texas State Board of Social Worker Examiners Application Checklist
Tx State Bd of Social Worker Examiners - 836
Electronic File
F01-13068
EMS Provider License Administrator Information
EMS - 791
Forms
EF23-12981
Food Manufacturer-Minor Amendment Change
Food Licensing -146
Electronic File
EF18-11669
Physician's Written Statement (Asbestos Program)
Asbestos Program - 361
Electronic File
EF02-13364
Licensed Chemical Dependency Counselor Intern Clinical Training Institution (CTI) Assessment Form
Licensed Chemical Dependency Counselor 849
Electronic File
EF18-11675
Asbestos Consultant Agency License Application
Asbestos Program - 361
Electronic File
EF18-11674
Asbestos License Application/Renewal Abatement Supervisor
Asbestos Program - 361
Electronic File
EF18-11673
Asbestos License Application/Renewal Asbestos Worker
Asbestos Program - 361
Electronic File
EF18-11672
Asbestos Contractor License Application
Asbestos Program - 361
Electronic File
EF18-11677
Asbestos Application/Renewal Individual Asbestos Consultant
Asbestos Program - 361
Electronic File
EF18-11670
Asbestos Operations & Maintenance Contractor (Restricted) License Application
Asbestos Program - 361
Electronic File
EF18-11678
Asbestos Management Planner Agency License Application
Asbestos Program - 361
Electronic File
EF18-11668
Asbestos Application Individual Duplicate
Asbestos Program - 361
Electronic File
EF18-11667
Asbestos Application Individual Name Change
Asbestos Program - 361
Electronic File
EF18-11665
Asbestos License New/Renewal Training Provider
Asbestos Program - 361
Electronic File
EF18-11664
State Accreditation Examination Registration Form (Asbestos Program)
Asbestos Program - 361
Electronic File
EF07-12272
Personal Emergency Response System (PERS) Providers Certificate of Proof of Liability Insurance
PERS Providers - 568
Electronic File
EF20-12919
Birthing Centers Renewal Application
Facility Licensing - 761
Electronic File
EF18-11671
Asbestos License Application/Renewal Operations & Maintenance Supervisor
Asbestos Program - 361
Electronic File
EF18-11692
Application for Company Name Change (Asbestos Program)
Asbestos Program - 361
Electronic File
EF23-12983
Salvage Establishments-Salvage Brokers-Minor Amendment Change
Food Licensing -146
Electronic File
EF20-12911
Inspection Application (Facility Licensing)
Facility Licensing - 752
Electronic File
EF20-12910
Plan Review Application (Facility Licensing)
Facility Licensing - 752
Electronic File
EF20-12909
Self Certification Info Packet (Facility Licensing)
Facility Licensing - 752
Electronic File
EF20-12376
Youth Camp Training Program Application
Environ/Consumer Safety 616
Electronic File
EF18-11676
Asbestos Application/Renewal Asbestos Inspector
Asbestos Program - 361
Electronic File
EF18-12249
Company Name Change (Environmental & Sanitation LicensingMold)
PSQA-Envir Hazards - 365
Electronic File
EF02-12273
Personal Emergency Response System (PERS) Providers Application for Registration
PERS Providers - 568
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 68 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF18-11691
Application for Asbestos Agency Duplicate License/Registration
Asbestos Program - 361
Electronic File
EF18-11683
Asbestos Transporter License Application
Asbestos Program - 361
Electronic File
EF18-11682
Asbestos Laboratory License Application
Asbestos Program - 361
Electronic File
EF18-11681
Asbestos Application/Renewal Air Monitor Technician
Asbestos Program - 361
Electronic File
EF18-11680
Asbestos License Application/Renewal Project Manager
Asbestos Program - 361
Electronic File
EF18-11679
Asbestos Application/Renewal Individual Management Planner
Asbestos Program - 361
Electronic File
EF20-11979
Youth Camp & Day Camp Application
Environ/Consumer Safety 616
Electronic File
252-2b
Preceptor Statement for License Application
Radiation Control - 326
Forms
EF02-13440
Application for Licensure Dyslexia Therapist or Dyslexia Practitioners
Dyslexia Therapist - 877
Electronic File
BRC230ACF-2
Checklist for Interpreting Physicians
Radiation Control - 21
Forms
BRC230A&C
Application for Mammography Accreditation and Certification
Radiation Control - 21
Forms
77-13302
LCSW/LMSW-AP Independent Practice Recognition Application Forms Packet
Tx State Bd of Social Worker Examiners - 337
Forms
42-3
Radiation Safety Officer - RSO Information for Registration
Radiation Control - 326
Electronic File
BRC230ACF-4
Checklist for Medical Physicists
Radiation Control - 21
Forms
301-2
Application for Registration of Lasers and Laser Services
Radiation Control - 326
Electronic File
BRC230C-1
Application for Mammography Certification
Radiation Control - 21
Forms
252-2a
Application for Radioactive Material License (Medical Uses)
Radiation Control - 326
Electronic File
252-2
Application for Radioactive Material License
Radiation Control - 326
Electronic File
226-3
Application for Registration of Industrial Radiation Machines and Services
Radiation Control - 326
Electronic File
226-2
Registration Application for Users of Radiation Machines in Healing Arts, Veterinary Med, & Academic
Radiation Control - 326
Electronic File
226-1
Franchise Tax Information Form (Regulatory Services- Radiation)
Radiation Control - 326
Electronic File
F18-11692
Application for Company Name Change (Asbestos Program)
Asbestos - 148
Forms
301-3
Written Notice for Laser Light Show in Texas
Radiation Control - 326
Electronic File
EF01-13066
EMS Provider License Declaration Form
EMS - 792
Electronic File
EF02-12271
Personal Emergency Response System (PERS) Providers Application for License
PERS Providers - 568
Electronic File
EF01-13072
EMS Provider License Notification/Changes
EMS - 792
Electronic File
EF01-13071
EMS Provider-Medical Director Information Form
EMS - 792
Electronic File
EF01-13070
EMS Provider Vehicle Form
EMS - 792
Electronic File
EF01-13069
EMS Provider License-Personnel
EMS - 792
Electronic File
BRC230ACF-3
Checklist for Radiologic Technologist
Radiation Control - 21
Forms
EF01-13067
EMS Provider License Application
EMS - 792
Electronic File
EF20-12920
Ambulatory Surgical Center (ASC) Renewal Application
Facility Licensing - 761
Electronic File
EF01-13065
EMS Provider License Certificate / Vehicle Authorization Replacement Request
EMS - 792
Electronic File
E77-13302
LCSW/LMSW-AP Independent Practice Recognition Application Forms Packet
Tx State Bd of Social Worker Examiners - 835
Electronic File
BRC252-3
Notice of Intent to Work in Texas Under Reciprocity
Radiation Control - 326
Forms
BRC251-2
Application for a General License Acknowledgement of Devices Containing Radioactive Material
Radiation Control - 326
Forms
BRC251-1
Application for a General License Acknowledgement for in vitro Clinical or Lab Testing
Radiation Control - 326
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 69 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
BRC230C-2
Application for Adding Equipment to Mammography Certification
Radiation Control - 21
EF01-13068
EMS Provider License Administrator Information
EMS - 792
Electronic File
EF23-12982
Bottled Water Operators Certificate of Competency Exam Application
Food Licensing -146
Electronic File
EF23-12974
Retail Food Operation-Food Establishment-Food Store-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12992
Certified Food Manager (CFM) Recertification - Initial, Renewal
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12991
Certified Food Manager (CFM) Certification - Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12990
Certified Food Manager (CFM) Certification - Initial, Renewal, or Change of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12989
Certified Food Manager (CFM) Food Handler Program - Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12994
Certified Food Manager (CFM) Test Site - Initial Renewal
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12984
Salvage Establishments-Salvage Brokers-Initial, Renewal, or Change of Ownership (including legal
Food Licensing -146
Electronic File
EF23-12995
Certified Food Manager (CFM) Test Site - Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12980
Food Warehouse Operator-Initial, Renewal, or Change of Ownership (including Legal entity)
Food Licensing -146
Electronic File
EF23-12979
Food Warehouse Operator-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12978
Food Wholesaler License-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12977
Food Wholesaler Registration-Initial, Renewal, or Change of Ownership (including legal entity)
Food Licensing -146
Electronic File
EF23-12976
Food Wholesaler Registration-Minor Amendment Change
Food Licensing -146
Electronic File
EF20-12912
Final Construction Approval Form (Facility Licensing)
Facility Licensing - 752
Electronic File
EF23-12987
Certified Food Manager (CFM) Certificate - Renewal/Replacement Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13002
Drug Distributor-Nonprescription Drugs License App-Initial, Renewal, or Chg of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13009
Drug Manufacturer-Prescription Drugs License Application-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13008
Drug Manufacturer-Prescription Drugs License App-Initial, Renewal, or Change of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13007
Drug Manufacturer-Nonprescription Drugs License ApplicationMinor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13006
Drug Manufacturer-Nonprescription Drugs License App-Initial, Renewal, or Chg of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13005
Drug Distributor-Prescription Drugs License Application-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12993
Certified Food Manager (CFM) Recertification - Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13003
Drug Distributor-Nonprescription Drugs License App-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12972
Food Establishment Inspection Application
Food Licensing -146
Electronic File
EF23-13001
Device Distributor-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13000
Device Manufacturer-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12999
Out-of-State Drug Distributor-Prescription Drugs License Application-Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
Stock #4-25-lang Revised 10/25/2010
Forms
Page 70 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
EF23-12998
Certified Food Manager (CFM) Food Handler Program - Initial, Renewal
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12997
Certified Food Manager (CFM) Examination Booklet Order - Test Sites
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12996
Certified Food Manager (CFM) Examination Booklet Order Program Sites
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13004
Drug Distributor-Prescription Drugs License App-Initial, Renewal, or Change of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10504
Salvage Establishment/Salvage Broker License Application (Food Salvage)
Food Licensing -146
Electronic File
EF23-12975
Retail Food Operation-Childcare-School-Roadside Vendor-Mobile Food Vendor-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-10613
Tanning Facilities License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10611
Drug Distributor License Verification Affidavit
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10609
Multiple Product Licenses Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10603
Temporary Food Establishment Permit Application - 1 Event
Food Licensing -146
Electronic File
EF23-10619
Body Piercing Studio License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10505
Food Wholesaler License Application
Food Licensing -146
Electronic File
EF23-10621
Device Manufacturer License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF20-12926
Birthing Centers Initial Application
Facility Licensing - 761
Electronic File
EF20-12925
End-Stage Renal Disease Facility (ESRD) Initial Application
Facility Licensing - 761
Electronic File
EF20-12924
Abortion Facility Initial Application
Facility Licensing - 761
Electronic File
EF20-12923
Ambulatory Surgical Center (ASC) Initial Application
Facility Licensing - 761
Electronic File
EF20-12922
End-Stage Renal Disease Facility (ESRD Renewal Application
Facility Licensing - 761
Electronic File
EF20-12921
Abortion Facility Renewal Application
Facility Licensing - 761
Electronic File
EF23-10597
Retail Food Operation Permit Application
Food Licensing -146
Electronic File
EF23-10859
Childcare/School/Roadside Vendor/Mobile Unit Food Establishment Permit Application
Food Licensing -146
Electronic File
EF23-12971
Shellfish Processing Facility
Food Licensing -146
Electronic File
EF23-12970
Retail Temporary Food Establishment-Multiple Events
Food Licensing -146
Electronic File
EF23-12969
School Food Establishment Inspection Application
Food Licensing -146
Electronic File
EF23-12968
Crabmeat Processing Facility
Food Licensing -146
Electronic File
EF23-12967
Certificate of Freesale and Sanitation and/or Certificate of Origin
Food Licensing -146
Electronic File
EF23-10618
Tattoo Studio License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12957
Certificate of Authority Minor Amendment (Drugs & Food Safety Licensing)
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13010
Multiple Products (Nonprescription Drugs-Food-Devices)-Initial, Renewal, or Change of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10858
Device Distributor License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10857
Bloodborne Pathogen Control Program Device Registration Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10856
Drug Distributor (Manufacturer) License Application
Drugs & Food Safety Licensing - 89
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 71 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF23-10855
Drug Distributor License Applications For Out of State Firms
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10854
Drug Distributor License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10853
Food Manufacturer License Application
Food Licensing -146
Electronic File
EF23-12958
Certificate of Authority (Drugs & Food Safety Licensing)
Drugs & Food Safety Licensing - 89
Electronic File
F76-10784
Audiology Course Work and Clinical Experience Form
State Bd of Examiners Speech & Audiology - 129
Forms
F75-10963
St Bd of Exam of Prof Counselors-Supervised Experience Documentation Form
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-10966
St Bd of Exam of Prof Counselors-Supervisor Application Form
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-10967
St Bd of Exam of Prof CounselorsSupervisory Agreement Form
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-11283
Professional Licensing and Certification Division Request to Withhold Personal Information Form
Professional Licensing and Certification - 98
Forms
F75-13345
Course Evaluation / Licensing Information Sheet
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F76-10795
St Bd Exam for Speech-Lang Pathology and Audiology-Rec of Cont Educ Hrs Earned Used
State Bd of Examiners Speech & Audiology - 129
Forms
F75-13407
Verification of Licensure in Other Jurisdiction (Professional Counselor)
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-10759
St Bd Exam of Professional Counselors - Counselor Cont Education Declaration
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F76-10787
Speech-Language Pathology Course Work and Clinical Experience Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10788
St Bd Exam for Speech-Lang Pathology and Audiology-Alt Meth for Assistant to Obtain Clinical Observ
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10789
St Bd Exam for Speech-Lang Pathology and Audiology - Application Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10790
St Bd Exam for Speech-Lang Pathology and Audiology-Clinical Observ & Exp for Assts. Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10792
St Bd Exam for Speech-Lang Pathology and Audiology-Fitting & Disp of Hearing Instr Reg
State Bd of Examiners Speech & Audiology - 129
Forms
F72-10745
Dietitian Application for Licensure
Tx State Bd of Examiners of Dietitians - 127
Forms
F75-13346
LPC Application Packet
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F73-12962
Form B-Texas State Board of Marriage and Family Therapists Renewal Application Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F72-12124
Dietitian Renewal Form
Tx State Bd of Examiners of Dietitians - 127
Forms
F73-10748
Texas State Board of Examiners of Marriage & Family Therapists Application Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-10751
Tx St Bd of Examiners of Marriage & Family Therapists -Supervised Experience Doc Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-10752
Tx St Bd of Examiners of Marriage and Family Therapists Supervisor Application
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-10753
Tx St Bd of Examiners of Marriage and Family Therapists Supervisory Agreement Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
Stock #4-25-lang Revised 10/25/2010
Page 72 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F73-12959
Form I-Course Equivalency Request (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F75-10962
St Bd of Exam of Prof Counselors-Practicum Documentation
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F73-12961
Form IV-Probation/Monitoring Supervision Plan (for licensees under board ordered supervision)
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F75-10781
St Bd of Examiners of Prof Counselors-Pre-Approved Cont Educ Prov Appl
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F73-12963
Form B-Continuing Education Provider Approval Application/Renewal (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-12964
Form VI-Supervised Clinical Practicum Supervision and Experience Verification Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-12965
Form VII-Examination Security Information Acknowledgement Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F74-10755
Licensed Perfusionist or Provisional Licensed Perfusionist
Tx State Bd of Examiners of Perfusionists - 135
Forms
F75-10757
Licensed Professional Counselor - Application Packet
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F76-10796
St Bd Exam for Speech-Lang Pathology and Audiology - Report of Completed Internship Form
State Bd of Examiners Speech & Audiology - 129
Forms
F73-12960
Form II-Verification of Licensure in Other Jurisdiction (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
G-20
Texas DSHS Dairy Water Form
Milk Group - 746
Forms
F77-13400
Clinical Supervision Plan (Form III)
Tx State Bd of Social Worker Examiners - 337
Forms
F77-13401
Non-Clinical Supervision Plan (Form IV)
Tx State Bd of Social Worker Examiners - 337
Forms
F77-13402
Board-Ordered Supervision Plan (Form IX)
Tx State Bd of Social Worker Examiners - 337
Forms
F82-11517
Statement of Continuing Education (Code Enforcement)
Code Enforcement Officers - 186
Forms
F82-11518
Statement of Continuing Education (Registered Sanitarian)
Registered Sanitarian - 36
Forms
F76-10793
St Bd Exam for Speech-Lang Pathology and Audiology - Intern Plan & Agreement of Sup Form
State Bd of Examiners Speech & Audiology - 129
Forms
F82-11947
Commercial Education Business Continuing Education Provider Application/Agreement (Prof Sanitarian)
Registered Sanitarian - 36
Forms
F77-11663
St Bd of Social Worker Exam-Supervision Verification for Adv Clinical Practitioner/Adv Pra (ACP/AP)
Tx State Bd of Social Worker Examiners - 337
Forms
LRS-17
Termination of a Registraton or Certification (Regulatory ServicesRadiation)
Radiation Control - 326
Electronic File
LRS-18R
Radiation Machine Transfer/Disposal Form
Radiation Control - 326
Electronic File
LRS-35
Additional Information for Accelerator Registration, Includes Shielding Form
Radiation Control - 326
Electronic File
MSA-12
Construction Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
MSA-13
Operators Rendering Application
Drugs & Food Safety Licensing - 89
Electronic File
EF75-10757
Licensed Professional Counselor - Application Packet
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
F82-11543
Sanitarian Application for Registration
Registered Sanitarian - 36
Forms
Stock #4-25-lang Revised 10/25/2010
Page 73 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F77-10802
Texas State Board of Social Worker Examiners - CEU Provider Appl Proc Packet
Tx State Bd of Social Worker Examiners - 93
Forms
F76-10797
St Bd Exam for Speech-Lang Pathology and Audiology-Superv Resp Statement for Assts
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10798
Supervision Log - Speech-Language Pathology and Audiology
State Bd of Examiners Speech & Audiology - 129
Forms
F76-11925
Renewal Form for Web site (State Board of Examin for Speech/Audiology)
State Bd of Examiners Speech & Audiology - 129
Forms
F76-12381
Exception Request to Supervising with Less Than Three Years Experience (Speech-Language Pathology)
State Bd of Examiners Speech & Audiology - 129
Forms
F76-12382
Exception Request to Supervising More than Four Interns/Assistants (Speech-Language Pathology)
State Bd of Examiners Speech & Audiology - 129
Forms
F76-12586
Application to Upgrade Intern License to Full Licensure
State Bd of Examiners Speech & Audiology - 129
Forms
F77-13336
Form V-Clinical Supervision Verification for LCSW
Tx State Bd of Social Worker Examiners - 93
Forms
F77-10801
ACP/AP Supervision Forms Packet (Texas State Board of Social Worker Examiners)
Tx State Bd of Social Worker Examiners - 93
Forms
F77-13303
Texas State Board of Social Worker Examiners Application Checklist
Tx State Bd of Social Worker Examiners - 93
Forms
F77-11570
Alternative Method of Examining Competency
Tx State Bd of Social Worker Examiners - 337
Forms
F77-11659
St Bd of Social Worker Exam-Application to be a Supervisor
Tx State Bd of Social Worker Examiners - 337
Forms
F77-11660
St Bd of Social Worker Exam-Social Work License Renewal Form
Tx State Bd of Social Worker Examiners - 337
Forms
F77-11661
St Bd of Social Worker Exam-Supervision Plan
Tx State Bd of Social Worker Examiners - 337
Forms
F77-11662
St Bd of Social Worker Exam-Supervision Verification for SWA (Social Worker Associate)
Tx State Bd of Social Worker Examiners - 337
Forms
F82-12008
Request for Retired Professional Sanitarian Exemption Form
Registered Sanitarian - 36
Forms
F76-13408
Alternate Supervision of an Assistant Request Plan
State Bd of Examiners Speech & Audiology - 129
Forms
F62-13348
Supervison Form
Council on Sex Offender Treatment - 118
Forms
F65-10711
Medical Radiologic Technologist Certification - Appl for Hardship Exemption
Medical Radiologic Technologist Certif Prog 123
Forms
F65-10710
Medical Radiologic Technologist Certification Application
Medical Radiologic Technologist Certif Prog 123
Forms
F64-13397
Massage Therapy Educational Program Application for Basic 500Hour Program
Massage Therapy Program - 122
Forms
F64-13023
Continuing Education Provider Application/Agreement
Massage Therapy Program - 122
Forms
F64-10706
Massage Therapy Registration Program - Massage School/Ind Instructor Reg
Massage Therapy Program - 122
Forms
F64-10704
Massage Therapy Reg Program-Appl for School-Based Massage Therapy Instr
Massage Therapy Program - 122
Forms
F64-10703
Massage Therapy Registration Program - Additional/New Main Location Appl
Massage Therapy Program - 122
Forms
F64-10702
Massage Therapy Registration Program - Additional Program Application
Massage Therapy Program - 122
Forms
F64-10701
Massage Therapy Registration Application
Massage Therapy Program - 122
Forms
Stock #4-25-lang Revised 10/25/2010
Page 74 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F65-13332
Application for Limited Education Program
Medical Radiologic Technologist Certif Prog 123
Forms
F62-13349
Application Cover Letter Form
Council on Sex Offender Treatment - 118
Forms
F60-13340
Athletic Trainer Application Packet
Advisory Board of Athletic Trainers - 121
Forms
F62-13347
Contract of Supervision for ASOTP or PSOTP
Council on Sex Offender Treatment - 118
Forms
F61-10684
Application for Contact Lens Disp Permit - Individual or Sole Proprietor
Contact Lens Dispensing Permit Program - 131
Forms
F61-10683
Application for Contact Lens Disp Permit-Corp or Other Business Entity
Contact Lens Dispensing Permit Program - 131
Forms
F60-12125
Athletic Trainer License Renewal Form
Advisory Board of Athletic Trainers - 121
Forms
F60-10681
Athletic Trainer License Application Packet
Advisory Board of Athletic Trainers - 121
Forms
F20-12376
Youth Camp Training Program Application
Public Health Sanitation 341
Forms
F20-11979
Youth Camp & Day Camp Application
Environ/Consumer Safety 15
Forms
F18-12249
Company Name Change (Environmental & Sanitation LicensingMold)
PSQA-Envir Hazards - 405
Forms
F71-10741
Texas Board of Orthotics and Prosthetics - Licensure Application Packet
Tx Bd of Orthotics & Prosthetics - 130
Forms
F63-10698
Request to Establish a Registry for a Health-related Occupation
Health-Related Services Registry - 132
Forms
F68-10730
Respiratory Care Practitioners Certif Program - Late Renewal Deficiency Notification
Respiratory Care Pract. Certif. Program - 843
Forms
F69-13399
Application for Continuing Education Sponsor (Hearing Instruments)
St. Comm. Examrs. In Fit & Disp. Hear Instr - 126
Forms
F69-13300
Application Form Temporary Training Permit
St. Comm. Examrs. In Fit & Disp. Hear Instr - 126
Forms
F65-13344
Affidavit for Continuing Education Exemption (Medical Radiologic Technologist)
Medical Radiologic Technologist Certif Prog 123
Forms
F69-11967
Application for Continuing Education Program Approval - Fitting & Disp of Hearing Instruments
St. Comm. Examrs. In Fit & Disp. Hear Instr - 126
Forms
F69-10733
State Comm of Exam in Fitting & Disp of Hearing InstrumentsApplication Form
St. Comm. Examrs. In Fit & Disp. Hear Instr - 126
Forms
F70-10737
Texas Board of Licensure for Professional Medical Physicists License Appl Packet
Tx Bd Licensure for Prof. Medical Physicists - 134
Forms
F71-10740
Texas Board of Orthotics and Prosthetics - Facility Accreditation Application Packet
Tx Bd of Orthotics & Prosthetics - 130
Forms
F69-11751
Hearing Instrument Fitters and Dispensers Complaint Reporting Form
St. Comm. Examrs. In Fit & Disp. Hear Instr - 126
Forms
F68-10726
Respiratory Care Practitioners Application Packet
Respiratory Care Pract. Certif. Program - 843
Forms
F67-12090
Statement of Continuing Education Form for Opticians
Optician's Registry Program - 133
Forms
F66-10716
Midwife Documentation Application
Midwifery Program - 124
Forms
F66-10717
Midwife Informed Choice and Disclosure Statement
Midwifery Program - 124
Forms
F68-13333
Practioner of Respiratory Care State Certification/Registration Verification Form
Respiratory Care Pract. Certif. Program - 843
Forms
F66-10715
Midwife - Newborn Screening Test Objection Form
Midwifery Program - 124
Forms
Stock #4-25-lang Revised 10/25/2010
Page 75 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F66-10718
Midwife Training Certification Form - Newborn Screening Specimen Collection
Midwifery Program - 124
Forms
F66-10719
Newborn Screening Agreement for Newborn Babies of Midwife Clients
Midwifery Program - 124
Forms
F66-13412
Supervising Midwife/Apprentice Complaint Disclosure Form
Midwifery Program - 124
Forms
F67-10722
Opticians Registry - Application for Optician Registration
Optician's Registry Program - 133
Forms
Forms-Public Information / Formularios--informacion publica EF49-11631
Open Records Requests (HazCom Info)
Tier Two - 349
Electronic File
EF10-11698
Request for Confidential Cancer Registry Data
Cancer Epi/Surv - 369
Forms
EORREPORT
Open Records Report Form
Off. of Gen. Counsel - 115
Electronic File
F49-11631
Open Records Request (HazCom Info)
Policy, Standards, & Quality Assurance Unit 100
Forms
EORBILL
Public Records Charges Billing Form
Off. of Gen. Counsel - 115
Electronic File
EORREP
Open Records Repetitous Request Response Form
Off. of Gen. Counsel - 115
Electronic File
Forms-Purchasing & Inventory / Formularios--compras e inventario DSHS-AM08
Surplus Listing
Asset Mgmt - 3
Electronic File
DSHS-AM04
Purchase Order Receipt Order Confirmation
Asset Mgmt - 3
Electronic File
Acq-Cert
Certificate of Acquisition by Political Subdivision or Assistance Organization (HHS Enterprise)
Asset Mgmt - 3
Electronic File
DSHS-AM03
Property Auction/Sealed Bid (Mental Hospitals only)
Asset Mgmt - 3
Electronic File
DSHS-AM09
Equipment Loan/Checkout
Asset Mgmt - 3
Electronic File
DSHS-AM10
Periodic Inventory
Asset Mgmt - 3
Electronic File
PO ADJUST
Purchase Order Adjustment Form
Accounting-Claims Processing - 700
Electronic File
EB-72
Petty Cash Fund Expenditure Record
Accounting-General Ledger - 94
Electronic File
HHS-ECPS.01
Justification for Emergency Purchase
Enterprise Procurement 729
Electronic File
HHS-AM06
Interagency Equipment Transfer Record (HHS Enterprise)
Asset Mgmt - 3
Electronic File
HHS-AM05
Request to Salvage Property (HHS Enterprise)
Asset Mgmt - 3
Electronic File
HHS-AM03
Property Auction/Sealed Bid (HHS Enterprise)
Asset Mgmt - 3
Electronic File
HHS-AM02
Missing, Stolen or Damaged Property Report (HHS Enterprise)
Asset Mgmt - 3
Electronic File
HHS-AM01
Individual Inventory/Equipment Transfer Record (HHS Enterprise)
Asset Mgmt - 3
Electronic File
HHS-ECPS.02
Justification for Proprietary and/or Sole Source Purchase
Enterprise Procurement 729
Electronic File
Forms-Reporting / Formularios--reportajes EF11-10934
Contact Summary Report for Perinatal Hepatitis B Prevention
Infectious Disease - 668
Electronic File
EF11-11014
Physician's Prenatal Report HBsAg-Positive Mother
Infectious Disease - 668
Electronic File
EF15-11876
Brucellosis Case Investigation Form
Zoonosis - 448
Electronic File
EF15-11877
Lyme Disease Case Investigation Form
Zoonosis - 448
Electronic File
EF15-11878
Mosquito-borne Illness Case Investigation Form
Zoonosis - 448
Electronic File
EF15-11875
Anthrax Case Investigation Form
Zoonosis - 448
Electronic File
EF12-12274
Report of Serious Adverse Drug Reaction Resulting in Hospitalization or Death
Infectious Disease Control Unit - TB - 320
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 76 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F50-12589
Infectious Disease Reporting Form
ERT-HSR 1 - 693
Forms
EF12-12104
TB Incident Report
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-11494
TB Questionnaire (English)
Infectious Disease Control Unit - TB - 320
Electronic File
EF11-10931
Infant Summary Report for Perinatal Hepatitis B Prevention
Infectious Disease - 668
Electronic File
EF11-11015
Hospital Delivery Report of HBsAg-Positive Mother
Infectious Disease - 668
Electronic File
CDC525
(CDC 52.5) Typhoid Fever Surveillance Report (CDC)
Infectious Disease - 185
Electronic File
EF11-10932
Mother Summary Report for Perinatal Hepatitis B Prevention
Infectious Disease - 668
Electronic File
EF12-12168
Monthly Tuberculin Skin Testing Form
Infectious Disease Control Unit - TB - 320
Electronic File
EF09-11927
Human Pesticide Exposure Report Form
Pesticide Exposure Surv (PEST) - 452
Electronic File
EF09-11624
Adult Blood Lead Reporting Form
Blood Lead Epi - 863
Electronic File
EC-12
Texas Hansen’s Disease Surveillance Form and Case Report
Infectious Disease - 629
Electronic File
E59-12781
Creutzfeldt-Jakob Disease Case Report Form
Infectious Disease - 185
Electronic File
E59-11574
Invasive Streptococcal Disease Case Report
Infectious Disease - 185
Electronic File
CDC5279
(CDC 52.79) Cholera & Other Vibrio Illnesses (Vibriosis Surveillance Form)
Infectious Disease - 185
Electronic File
EF11-11046
Varicella (Chickenpox) Reporting Form
Infectious Disease - 727
Electronic File
F09-11624
Adult Blood Lead Reporting Form
Blood Lead Epi - 862
Forms
EF15-11879
Q-Fever Case Investigation Form
Zoonosis - 448
Electronic File
EF15-11880
Tick-borne Relapsing Fever Case Investigation Form
Zoonosis - 448
Electronic File
EF15-11881
Rickettsial Disease Case Investigation Form
Zoonosis - 448
Electronic File
EF15-11882
Tularemia Case Investigation Form
Zoonosis - 448
Electronic File
EF15-11922
Plague Case Investigation
Zoonosis - 448
Forms
EF18-11669
Physician's Written Statement (Asbestos Program)
Asbestos Program - 361
Electronic File
EF18-12144
Mold Remediation Notification Form
PSQA-Envir Hazards - 365
Electronic File
EF49-11627
Tier Two Cover Sheet
Tier Two - 349
Electronic File
EF49-11628
Tier Two Chemical Description Sheet
Tier Two - 349
Electronic File
EF59-10666
Contaminated Sharps Reporting Form
Infectious Disease - 185
Electronic File
EF59-10874
Antibiotic Resistant Isolate Reporting Form
Infectious Disease - 185
Electronic File
EF59-91102
Legionellosis Case Report (Legionnaires' Disease Reporting Form)
Infectious Disease - 185
Electronic File
F09-11927
Human Pesticide Exposure Report Form
Pesticide Exposure Surv (PEST)- 702
Forms
F18-11669
Physician's Written Statement (Asbestos Program)
Asbestos - 148
Forms
F18-12144
Mold Remediation Notification Form
PSQA-Envir Hazards - 405
Forms
F51-12002
Report of Sexually Transmitted Diseases (STD-27) Form - Region 2/3
HSR 2/3 - 161
Forms
STD-6M
Sexually Transmitted Disease Record-Male
HIV/STD - 104
Forms
EF59-12608
Invasive Meningococcal (Neisseria meningitidis) Case Report
Infectious Disease - 185
Electronic File
F59-10666
Contaminated Sharps Reporting Form
Infectious Disease - 35
Forms
F59-91102
Legionellosis Case Report (Legionnaires' Disease Reporting Form)
Infectious Disease - 35
Forms
STD-6F
Sexually Transmitted Disease Record-Female
HIV/STD - 104
Forms
Stock #4-25-lang Revised 10/25/2010
Page 77 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Forms-Vital Statistics / Formularios de Estadisticas Vital FVS-166
Application for Amended Birth Certificate Based on Parentage
Vital Statistics - 71
Forms
FVS-172
Application to Amend Certificate of Death
Vital Statistics - 71
Forms
EFVS-166.532
Adoption Validation Order (for District Clerks)
Vital Statistics - 346
Electronic File
FVS-170
Application to Amend Certificate of Birth (Birth Certificate)
Vital Statistics - 71
Forms
EFVS-166.531
Adoption Validation Petition (for District Clerks)
Vital Statistics - 346
Electronic File
FVS-2318.1A
Application for Amended Birth Certificate based on a Court-Ordered Change of Name
Vital Statistics - 71
Forms
EFVS-166
Application for New Birth Certificate Based on Parentage
Vital Statistics - 346
Electronic File
EFVS-170
Application to Amend Certificate of Birth (Birth Certificate)
Vital Statistics - 346
Electronic File
FVS-301
Certificate of Birth Resulting in Stillborn Application (Birth Certificate)
Vital Statistics - 71
Forms
FVS-165
Suits Affecting Parent Child Relationship (Information on Suit Affecting the Family Relationship)
Vital Statistics - 71
Forms
FVS-160
Certificate of Adoption (for District Clerks)
Vital Statistics - 71
Forms
FVS-159.1M
Acknowledgement of Paternity
Vital Statistics - 71
Forms
FVS-141
Application for Certified Copy of Birth or Death Certificates (Birth Certificate)
Vital Statistics - 71
Forms
FVS-168
Inquiry on Court of Continuous Jurisdiction for a Child
Vital Statistics - 71
Forms
FVS-174
Amendment to Medical Certification of Certificate of Death
Vital Statistics - 71
Forms
EFVS-160
Certificate of Adoption (for District Clerks)
Vital Statistics - 346
Electronic File
FVS-134.1
Acknowledgement of Paternity Inquiry Request
Vital Statistics - 71
Forms
FVS-180
Application for Marriage License
Vital Statistics - 71
Forms
EFVS-172
Application to Amend Certificate of Death
Vital Statistics - 346
Electronic File
EFVS-180.1
Declaration and Registration of Informal Marriage
Vital Statistics - 760
Electronic File
FVS-180.1
Declaration and Registration of Informal Marriage
Vital Statistics - 71
Forms
EFVS-2318.1A
Application for Amended Birth Certificate based on a Court Ordered Name Change
Vital Statistics - 346
Electronic File
EFVS-271
Application for Disinterment Permit (Vital Statistics)
Vital Statistics - 346
Electronic File
FVS-271
Application for Disinterment Permit (Vital Statistics)
Vital Statistics - 71
Forms
FVS-271.1
Disinterment Consent Form (Vital Statistics)
Vital Statistics - 71
Forms
EFVS-271.1
Disinterment Consent Form (Vital Statistics)
Vital Statistics - 346
Electronic File
EFVS-165
Suits Affecting Parent Child Relationship (Information on Suit Affecting the Family Relationship)
Vital Statistics - 760
Electronic File
EFVS-168
Inquiry on Court of Continuous Jurisdiction for a Child
Vital Statistics - 760
Electronic File
EFVS-142.31
Application for Birth or Death Record - Certified (credit card) (Birth Certificate)
Vital Statistics - 346
Electronic File
EFVS-130
Notice of Intent to Claim Paternity
Vital Statistics - 760
Electronic File
EFVS-131
Paternity Registry Notice of Change of Information
Vital Statistics - 760
Electronic File
EFVS-132
Revocation of Notice of Intent to Claim Paternity
Vital Statistics - 760
Electronic File
EFVS-133
Denial of Registrants' Paternity
Vital Statistics - 760
Electronic File
EFVS-134
Paternity Registry Inquiry Request
Vital Statistics - 346
Electronic File
EFVS-134.1
Acknowledgement of Paternity Inquiry Request
Vital Statistics - 346
Electronic File
EFVS-141
Application for Certified Copy of Birth or Death Certificates (Birth Certificate)
Vital Statistics - 760
Forms
Stock #4-25-lang Revised 10/25/2010
Page 78 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EFVS-142.2
Expedited Application for a Certified copy of a Birth or Death Record (fax) (Birth Certificate)
Vital Statistics - 346
Electronic File
EFVS-115
Report of Death
Vital Statistics - 759
Electronic File
EFVS-142.3
Mail Application for a Certified copy of a Birth or Death Record (Birth Certificate)
Vital Statistics - 346
Electronic File
EFVS-143
Request for Identity of Court of Adoption
Vital Statistics - 346
Electronic File
EFVS-142.6
Mail Application for a Verification of a Birth or Death Record (Birth Certificate)
Vital Statistics - 346
Electronic File
EFVS-142.61
Application for Birth or Death Verification (credit card payment)
Vital Statistics - 346
Electronic File
EFVS-142.7
Application for Birth Record - Certified - Military Personnel Being Deployed (Birth Certificate)
Vital Statistics - 346
Electronic File
EFVS-142.9
Mail Application for a Verification of Marriage and Divorce
Vital Statistics - 346
Electronic File
EFVS-142.91
Application for Marriage or Divorce Verification (credit card payment)
Vital Statistics - 346
Electronic File
EFVS-144
Heirloom Gift Certificate (Vital Statistics)
Vital Statistics - 346
Electronic File
EFVS-146
Application for an Heriloom Wedding Anniversary Certificate
Vital Statistics - 346
Electronic File
FVS-134
Paternity Registry Inquiry Request
Vital Statistics - 71
Forms
EFVS-180
Application for Marriage License
Vital Statistics - 760
Electronic File
EFVS-142.21
Expedited Application for Birth or Death Record - Certified (credit card)(Birth Certificate)
Vital Statistics - 346
Electronic File
FVS-113
Certificate of Fetal Death
Vital Statistics - 71
Forms
EFVS-145
Adult Adoptee Application for Non-Certified copy of Original Birth Certificate
Vital Statistics - 346
Electronic File
FVS-132
Revocation of Notice of Intent to Claim Paternity
Vital Statistics - 71
Forms
FVS-130
Notice of Intent to Claim Paternity
Vital Statistics - 71
Forms
FVS-128
Court-Ordered Delayed Certificate of Death
Vital Statistics - 71
Forms
EFVS-109.2
Medical Data Worksheet for Child's Birth Certificate
Vital Statistics - 758
Electronic File
FVS-115
Report of Death
Vital Statistics - 71
Forms
FVS-131
Paternity Registry Notice of Change of Information
Vital Statistics - 71
Forms
FVS-112
Certificate of Death
Vital Statistics - 71
Forms
FVS-111
Certificate of Birth (2005) Long form (restricted distribution) (Birth Certificate)
Vital Statistics - 71
Forms
EFVS-100
Requisition for Texas Vital Statistics Forms
Vital Statistics - 71
Electronic File
FVS-109.1
Mother's Worksheet for Birth Certificate (2005)
Vital Statistics - 71
Forms
FVS-101
Batch Control Form
Vital Statistics - 71
Forms
EFVS-301
Certificate of Birth Resulting in Stillborn Application (Birth Certificate)
Vital Statistics - 346
Electronic File
DSHS-EIA
Emergency Induced Abortion Certification Form
Vital Statistics - 346
Electronic File
FVS-109.2
Medical Data Worksheet for Child's Birth Certificate
Vital Statistics - 71
Forms
FVS-116
Burial-Transit Permit (restricted distribution)
Vital Statistics - 71
Forms
EFVS-109.1
Mother's Worksheet for Birth Certificate (2005)
Vital Statistics - 758
Electronic File
Gambling / Juegos de azar TCADA-46
Texas Survey of Adult Gambling Behavior
Mental Hlth/Sub Abuse 489
Electronic File
TCADA-45
Texas Survey of Adolescent Gambling Behavior
Mental Hlth/Sub Abuse 489
Electronic File
TCADA-44
Texas Survey of Adult and Adolescent Gambling Behavior
Mental Hlth/Sub Abuse 489
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 79 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
Genetics / Genetica E05-10580
Schedule of Assessment for PKU
Newborn Screening - 281
Electronic File
E05-10581
The Young Woman with PKU
Newborn Screening - 313
Electronic File
E05-10579
Sickle Cell Dis. in Children & Adolescents: Diagn., Gdlines for Comp. Care & Protocols for Mgt.
Newborn Screening - 313
Electronic File
E05-10549
Galactosemia Handbook: A Guide for Families
Newborn Screening - 318
Electronic File
E05-10451
A Teacher's Guide to Galactosemia
Newborn Screening - 318
Electronic File
E05-11339
Triple Screen
Genetics Services - 69
Electronic File
E1-194
Specimen Collection Guide
Newborn Screening - 68
Electronic File
E58-10957S
Birth Defect Risk Factor Series: Renal Agenesis
Birth Defects Epi - 324
Electronic File
E1-193
Texas Newborn Screening Program - A Practitioner's Guide
Newborn Screening - 254
Electronic File
E1-191
Homozygous Beta Thalassemia Major also known as Cooley's Anemia
Newborn Screening - 313
Electronic File
E06-10472
Newborn Screening Card
Newborn Screening - 319
Electronic File
E05-12102
Making Up Your Mind About PKU and Pregnancy (for young women with PKU ages 16-22 years old)
Newborn Screening - 281
Electronic File
E05-10897
Newborn Screening News
Newborn Screening - 153
Electronic Newsletter/Magazine
E05-11537
The ABCs of Congenital Adrenal Hyperplasia
Newborn Screening - 282
Electronic File
E05-10582
The Young Woman with Mild Hyperphenylalanemia
Newborn Screening - 281
Electronic File
E05-10832
Texas PKU Connections
Newborn Screening - 281
Electronic Newsletter/Magazine
E05-10822
Galactosemia Food Card
Newborn Screening - 318
Electronic File
E05-10632
The Child with Mild Hyperphenylalanemia
Newborn Screening - 281
Electronic File
E05-10589
Neonatal Screening: Blood Specimen Collection & Handling Procedure
Newborn Screening - 556
Electronic File
E05-10588
Simple Spot Check
Newborn Screening - 556
Electronic File
E05-10586
Questions You May Have for Your Genetic Specialist
Genetics Services - 69
Electronic File
E05-10583
Schedule of Assessment for Galactosemia
Newborn Screening - 318
Electronic File
E05-12101
Let's Focus on PKU and Pregnancy (for adolescents with PKU ages 11-15 years old)
Newborn Screening - 281
Electronic File
05-10832
Texas PKU Connections (Limit 5)
Newborn Screening - 67
Newsletters
E05-10004
The CAHOOT Newsletter
Newborn Screening - 282
Electronic Newsletter/Magazine
E05-03872
Sickle Beta+ Thalassemia
Newborn Screening - 313
Electronic File
E05-03871
Sickle Beta Zero Thalassemia
Newborn Screening - 313
Electronic File
E05-03870
Hemoglobin Sickle C Disease
Newborn Screening - 313
Electronic File
E05-02233
Hypothyroidism and Your Infant
Newborn Screening - 317
Electronic File
58-10955
Texas Birth Defects Monitor: A Semiannual Data and Research Update
Birth Defects Epi - 110
Newsletters
E05-03874
Pain in the Child with Sickle Cell Disease
Newborn Screening - 313
Electronic File
05-10897
Newborn Screening News
Newborn Screening - 67
Newsletters
E05-03875
Hemoglobin C Disease
Newborn Screening - 313
Electronic File
05-10779
Sickle Cell Disease Affects Us All - Where Are Your Roots? (Limit 5)
Newborn Screening - 136
Posters
05-10589
Neonatal Screening: Blood Specimen Collection & Handling Procedure (Limit 5)
Newborn Screening - 67
Posters
Stock #4-25-lang Revised 10/25/2010
Page 80 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
05-10588
Simple Spot Check (Limit 5)
Newborn Screening - 67
Posters
05-10004
The CAHOOT Newsletter
Newborn Screening - 67
Newsletters
05-06442
A Sickle Cell Coloring Book (Limit 5)
Newborn Screening - 136
Coloring Books
05-03113
Endocrinology Follow Up Post Card (Limit 5)
Newborn Screening - 136
Postcards
1-159
Texas Newborn Screening Program Bookmark (Limit 5)
Warehouse
Bookmarks
E05-06836
Newborn Screening Program Practitioner's Guide
Newborn Screening - 68
Electronic File
E05-10378
Sickle Cell Disease and Sickle Cell Trait
Newborn Screening - 313
Electronic File
E05-10372
Amniocentesis: For Prenatal Diagnosis
Genetics Services - 69
Electronic File
E05-10370
Some Important Points to Remember About Prenatal Testing
Genetics Services - 69
Electronic File
E05-10283
Minor Anomalies
Genetics Services - 69
Electronic File
E05-10282
Methods of Inheritance
Genetics Services - 69
Electronic File
E05-10119
Sickle Cell Disease: A Resource For the Educator
Newborn Screening - 313
Electronic File
E05-03873
Sickle Cell Anemia and Stroke
Newborn Screening - 313
Electronic File
E05-10093
When Does a Child/Adult Need Genetic Services?
Genetics Services - 69
Electronic File
E05-10450
A Teacher's Guide to PKU
Newborn Screening - 281
Electronic File
E05-03945
Sickle Cell Anemia: A Parent's Guide For the School Age Child
Newborn Screening - 313
Electronic File
E05-03880
Aplastic Crisis
Newborn Screening - 313
Electronic File
E05-03879
Priapism
Newborn Screening - 313
Electronic File
E05-03878
Splenic Sequestration Crisis
Newborn Screening - 313
Electronic File
E05-03877
Chest Syndrome
Newborn Screening - 313
Electronic File
E05-03876
Pneumococcal Infection and Penicillin
Newborn Screening - 313
Electronic File
E05-10103
Hemoglobin E
Newborn Screening - 313
Electronic File
E58-10957N
Birth Defect Risk Factor Series: Atrial Septal Defect
Birth Defects Epi - 324
Electronic File
E58-10957W
Birth Defect Risk Factor Series: 47,XYY
Birth Defects Epi - 324
Electronic File
E58-10957F
Birth Defect Risk Factor Series: Holoprosenchephaly
Birth Defects Epi - 324
Electronic File
E58-10957G
Birth Defect Risk Factor Series: Hydrocephaly
Birth Defects Epi - 324
Electronic File
E58-10957H
Birth Defect Risk Factor Series: NTDs
Birth Defects Epi - 324
Electronic File
E58-10957I
Birth Defect Risk Factor Series: Omphalocele
Birth Defects Epi - 324
Electronic File
E58-10957J
Birth Defect Risk Factor Series: Oral Clefts
Birth Defects Epi - 324
Electronic File
E58-10957K
Birth Defect Risk Factor Series: Trisomy 13
Birth Defects Epi - 324
Electronic File
E58-10957D
Birth Defect Risk Factor Series: Down Syndrome
Birth Defects Epi - 324
Electronic File
E58-10957M
Birth Defect Risk Factor Series: Anal Atresia
Birth Defects Epi - 324
Electronic File
E58-10957C
Birth Defect Risk Factor Series: Diaphragmatic Hernia
Birth Defects Epi - 324
Electronic File
E58-10957O
Birth Defect Risk Factor Series: Conotruncal Heart Defect
Birth Defects Epi - 324
Electronic File
E58-10957P
Birth Defect Risk Factor Series: Ear Defects
Birth Defects Epi - 324
Electronic File
E58-10957R
Birth Defect Risk Factor Series: Pyloric Stenosis
Birth Defects Epi - 324
Electronic File
E58-11040
Birth Defects Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E58-10957T
Birth Defect Risk Factor Series: Triploidy
Birth Defects Epi - 324
Electronic File
E58-10957U
Birth Defect Risk Factor Series: Turner Syndrome
Birth Defects Epi - 324
Electronic File
E58-10957V
Birth Defect Risk Factor Series: 47,XXX
Birth Defects Epi - 324
Electronic File
E58-10957L
Birth Defect Risk Factor Series: Trisomy 18
Birth Defects Epi - 324
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 81 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F66-10718
Midwife Training Certification Form - Newborn Screening Specimen Collection
Midwifery Program - 124
Forms
E1-196
Secondary Hypothyroidism Diagnosis and Treatment Guide
Newborn Screening - 317
Electronic File
E1-206
Congenital Adrenal Hyperplasia: A Handbook for Parents
Newborn Screening - 282
Electronic File
E1-318
These Tests Could Save Your Baby's Life: Newborn Screening Tests
Newborn Screening - 68
Electronic File
E1-319
What Parents Want to Know About Newborn Screening: From Their Baby's Health Professional
Newborn Screening - 68
Electronic File
E1-195
Primary Hypothyroidism Diagnosis and Treatment Guide
Newborn Screening - 317
Electronic File
E58-10957Q
Birth Defect Risk Factor Series: Intestinal Atresia/Stenosis
Birth Defects Epi - 324
Electronic File
E58-10957E
Birth Defect Risk Factor Series: Gastroschisis
Birth Defects Epi - 324
Electronic File
NBS-magnet
Step by Step: Your New Baby Must Have a Second Screening Test at 1-2 Weeks of Age (Limit 5)
Newborn Screening - 136
Magnets
F14-11419
Triple Screen Diagnosis Request Form
Labs - 30
Forms
E1-66
So Your Baby Has the Sickle Cell Trait
Newborn Screening - 313
Electronic File
F14-03252
Newborn Screening Supplies Order Form
Labs - 30
Forms
E1-68
The Infant and Young Child with Sickle Cell Anemia: A Guide Especially for Parents
Newborn Screening - 313
Electronic File
E58-10827
Birth Defects Glossary
Birth Defects Epi - 169
Electronic File
E58-10955
Texas Birth Defects Monitor: A Semiannual Data and Research Update
Birth Defects Epi - 169
Electronic Newsletter/Magazine
E58-10957B
Birth Defect Risk Factor Series: Craniosynostosis
Birth Defects Epi - 324
Electronic File
E1-63
Newborn Screening: For Your Baby's Health
Newborn Screening - 68
Electronic File
Grantsmanship & Fundraising / Busqueda de subvenciones y Recaudacion de fondos E32-10915
Funding Alert (weekly announcements)
Funding Info Center - 152
Electronic File
E32-10922
FIC (Funding Information Center) Bibliography
Funding Info Center - 552
Electronic File
EF29-11961
Nonprofit Board of Directors and Executive Director Assurances Form
Client Services Contracting - 701
Electronic File
Hansen's Disease / Enfermedad de Hansen EF12-11050
Foot Screen Record - Hansen's Disease
Infectious Disease - 629
Electronic File
HD-400
Texas Hansen's Disease Encounter Form
Hansen's Disease - 83
Forms
EC-12
Texas Hansen’s Disease Surveillance Form and Case Report
Infectious Disease - 629
Electronic File
ECD-001
Drug Therapy for Treatment of Hansen's Disease
Infectious Disease - 629
Electronic File
ECD-011
Disclosure & Consent Skin Scraping for Hansen's Disease Cases or Suspects
Infectious Disease - 629
Electronic File
EHD-400
Texas Hansen's Disease Encounter Form
Infectious Disease - 629
Electronic File
EF12-11051
Hand Screen Record - Hansen's Disease
Infectious Disease - 629
Electronic File
Smear/biopsy
Skin Smear/Biopsy Chart
Infectious Disease - 629
Electronic File
CD-001
Drug Therapy for Treatment of Hansen's Disease
Hansen's Disease - 83
Forms
EHDC-400
Texas Hansen's Disease Suspect/Contact Screen
Infectious Disease - 629
Electronic File
ECD-010
Disclosure and Consent Skin Biopsy for Hansen’s Disease Cases or Suspects
Infectious Disease - 629
Electronic File
Hantavirus Pulmonary Syndrome / Sindrome pulmonar por hantavirus E7-37
Hantavirus Pulmonary Syndrome
Stock #4-25-lang Revised 10/25/2010
Zoonosis - 376
Electronic File
Page 82 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
Health Care System / Sistema de atencion medica E25-12440
Exemption for HEDIS Reporting (Critieria)
Tx Hlth Care Info Collection - 647
Electronic File
E25-13044
2008 Hospital Nurse Staffing Survey (HNSS) Methods of Interim Staffing of Registered Nurses
TX Ctr Nursing Workforce - 673
Electronic File
E09-12945
The Top 5 Causes of Death, Disability, and Hospital Charges Due to Injury
Epidemiology/Injury Surveillance - 516
Electronic File
E25-11774
Top 25 Diagnoses, Health Care Financing Administration Diagnostic Related Groups (HCFA-DRGs)
Tx Hlth Care Info Collection - 301
Electronic File
E25-11847
Supply Trends Among Licensed Health Professions, Texas
Hlth Prof Resource Ctr 767
Electronic File
E25-12435
Commercial Product Basic Service HMOs
Tx Hlth Care Info Collection - 647
Electronic File
E25-12436
Indicators of Inpatient Care in Texas Hospitals, 2003
Tx Hlth Care Info Collection - 648
Electronic File
E25-12437
Indicators of Inpatient Care in Texas Hospitals, 2004
Tx Hlth Care Info Collection - 723
Electronic File
E25-13130
Texas Fact Sheet: Texas Psychiatric Hospitals Fact Sheet - 2007
Hlth Prof Resource Ctr 769
Electronic File
E25-12944
Texas Fact Sheet: Texas Psychiatric Hospitals Fact Sheet - 2006
Hlth Prof Resource Ctr 769
Electronic File
E25-13045
Safe Patient Handling in Texas Long Term Care Nursing Facilities
TX Ctr Nursing Workforce - 673
Electronic File
E25-13046
Staff Compensation and Benefits in Texas Long Term Care Nursing Faciliites
TX Ctr Nursing Workforce - 673
Electronic File
E25-13047
2008 Long Term Care Nurse Staffing Study (LTC NSS) Study Design and Methods
TX Ctr Nursing Workforce - 673
Electronic File
E25-13048
Turnover and Vacancy Rates in Texas Long Term Care Nursing Faciliites for RNs and LVNs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13049
Turnover and Vacancy Rates in Texas Long Term Care Nursing Faciliites for Unlicensed Nursing Staff
TX Ctr Nursing Workforce - 673
Electronic File
E25-13050
Vocational Nursing (VN) Programs: 2007 Student Admission, Enrollment, Graduation, and Student Demogr
TX Ctr Nursing Workforce - 673
Electronic File
E25-13051
Vocational Nursing (VN) Programs: 2007 Faculty Demographics
TX Ctr Nursing Workforce - 673
Electronic File
E25-13052
Vocational Nursing (VN) Programs: 2007 Geographic Location, Length of Curriculum, and Resources Need
TX Ctr Nursing Workforce - 673
Electronic File
E25-13053
Fact Sheet: 2008 Hospital Nurse Staffing Survey (HNSS) Expansion of Beds
TX Ctr Nursing Workforce - 673
Electronic File
E25-13054
Fact Sheet: 2008 Hospital Nurse Staffing Survey (HNSS) Vacancy and Turnover Rates
TX Ctr Nursing Workforce - 673
Electronic File
E25-13088
Physician Acceptance of Medicaid Patients in Texas
Hlth Prof Resource Ctr 715
Electronic File
E25-13435
Characteristics of New Physicians in Texas: 2000-2009
Hlth Prof Resource Ctr 662
Electronic File
E25-13091
Public Health Brief 2. Providers in the Health and Human Services Enterprise
Hlth Prof Resource Ctr 715
Electronic File
E25-12916
THCIC Data Collection, Outpatient THCIC 837 Technical Specifications
Tx Hlth Care Info Collection - 755
Electronic File
E25-13131
Texas Fact Sheet: Texas Acute Care Hospitals Fact Sheet - 2007
Hlth Prof Resource Ctr 769
Electronic File
E25-13145
The Supply of Pediatricians in Texas - 2008
Hlth Prof Resource Ctr 715
Electronic File
E25-13266
Public Health Brief 1. Functions in Federally Qualified Health Centers
Hlth Prof Resource Ctr 715
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 83 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E25-13267
Public Health Brief 2. Providers in Federally Qualified Health Centers
Hlth Prof Resource Ctr 715
Electronic File
E25-13268
Public Health Brief 3. Staffing Levels in Federally Qualified Health Centers
Hlth Prof Resource Ctr 715
Electronic File
E25-13269
Public Health Brief 4. Vacancies in Federally Qualified Health Centers
Hlth Prof Resource Ctr 715
Electronic File
E25-13270
Public Health Brief 5. Additional Workers Needed in Federally Qualified Health Centers
Hlth Prof Resource Ctr 715
Electronic File
E25-13271
Public Health Brief 6. Spotlight on Workers by Public Health Regions in Federally Qualified Health
Hlth Prof Resource Ctr 715
Electronic File
E25-13272
Public Health in Texas. The Public Health Workforce - Federally Qualified Health Centers
Hlth Prof Resource Ctr 715
Electronic File
E25-13361
Texas Fact Sheet: Texas Acute Care Hospitals Fact Sheet - 2008
Hlth Prof Resource Ctr 769
Electronic File
E25-13362
Texas Fact Sheet: Texas Psyciatric Hospitals Fact Sheet - 2008
Hlth Prof Resource Ctr 769
Electronic File
E25-13480
2011-2016 Texas State Health Plan-A Roadmap to a Healthy Texas
Statewide Health Electronic File Coordinating Council - 172
E25-13481
2011-2016 Texas State Health Plan-Executive Summary--A Roadmap to a Healthy Texas
Statewide Health Electronic File Coordinating Council - 172
E25-13089
Public Health in Texas: The Public Health Workforce-Health and Human Services Enterprise
Hlth Prof Resource Ctr 715
Electronic File
E25-12516
Highlights: Internationally Educated Nurses in Texas
TX Ctr Nursing Workforce - 673
Electronic File
E25-12447
Straight Talk on Texas HMOs
Tx Hlth Care Info Collection - 406
Electronic File
E25-12448
Texas Subset of HEDIS 2007
Tx Hlth Care Info Collection - 647
Electronic File
E25-12468
Top 25 Diagnoses, All-Patient Refined Diagnostic Related Groups (APR-DRGs)
Tx Hlth Care Info Collection - 301
Electronic File
E25-12471
Utilization of Specific Inpatient Procedures by Texas Hospital Referral Region
Tx Hlth Care Info Collection - 301
Electronic File
E25-12472
Your HMO Quality Check-up (Medicaid Reports)
Tx Hlth Care Info Collection - 406
Electronic File
E25-12473
Your HMO Quality Check-up (Medicare Reports)
Tx Hlth Care Info Collection - 406
Electronic File
E25-12474
Your HMO Quality Checkup (Regional Reports)
Tx Hlth Care Info Collection - 406
Electronic File
E25-12501
Recruitment and Retention of Health Care Providers in Underserved Communities in Texas
Hlth Prof Resource Ctr 662
Electronic File
E25-12508
The Feminization of the Health Care Workforce: Implications for Texas
Hlth Prof Resource Ctr 662
Electronic File
E25-12511
Texas Hospital Nurse Staffing Survey (2006)
TX Ctr Nursing Workforce - 673
Electronic File
E25-12512
Texas Hospital Nurse Staffing Survey (2006)-Executive Summary and Recommendation
TX Ctr Nursing Workforce - 673
Electronic File
E25-12513
Supply of and Demand for Registered Nurses and Nurse Graduates in Texas:Report to 80th Legislature
TX Ctr Nursing Workforce - 673
Electronic File
E25-13043
Directors of Nursing (DON) in Texas Long Term Care Nursing Facilities
TX Ctr Nursing Workforce - 673
Electronic File
E25-12515
Highlights: The Economic Impact of the Nursing Shortage
TX Ctr Nursing Workforce - 673
Electronic File
E25-12528
Highlights: The Supply of and Demand for Registered Nurses and Nurse Graduates in Texas: Rpt to Leg
TX Ctr Nursing Workforce - 673
Electronic File
E25-12901
Promoting Excellence Through Healthcare Workforce Planning in Texas - 2007
Hlth Prof Resource Ctr 662
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 84 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E25-12841
Professional Nursing Education in Texas - Demographics & Trends: 2006 Executive Summary
TX Ctr Nursing Workforce - 673
Electronic File
E25-12779
Health Professions Resource Center: Your Source for Health Provider Data
Hlth Prof Resource Ctr 715
Electronic File
E25-12778
Highlights: The Supply of Pediatricians in Texas - 2006
E25-12581
Highlights: The Supply of General Dentists in Texas - 2006
Hlth Prof Resource Ctr 662
Electronic File
E25-12514
Supply of and Demand for Registered Nurses and Nurse Graduates in Texas: Executive Summary/Recommend
TX Ctr Nursing Workforce - 673
Electronic File
E25-12529
Highlights: White Paper Briefs on Major Nursing Workforce Issues
TX Ctr Nursing Workforce - 673
Electronic File
E25-12443
Preventable Hospitalizations in Texas, 2002
Tx Hlth Care Info Collection - 301
Electronic File
E25-12522
Highlights: Texas Hospital Nurse Staffing Survey (2006)
TX Ctr Nursing Workforce - 673
Electronic File
E25-12521
Highlights: 2006 Expansion of Beds Survey
TX Ctr Nursing Workforce - 673
Electronic File
E25-12520
Highlights: Admission, Enrollment and Graduation Trends in Initial RN Licensure Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-12519
Highlights: Recruitment and Retention of Nursing Faculty
TX Ctr Nursing Workforce - 673
Electronic File
E25-12518
Highlights: Recruitment and Retention of Nurses in the Workforce
TX Ctr Nursing Workforce - 673
Electronic File
E25-12517
Highlights: Strategies to Retain Older, Experienced Nurses in the Workforce
TX Ctr Nursing Workforce - 673
Electronic File
E25-12556
Highlights: The Supply of Physician Assistants in Texas - 2006
Hlth Prof Resource Ctr 662
Electronic File
Electronic File
Health Catalogs / Catalogos de temas medicos E4-20-10
Women, Infants, Children Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E4-25-language
Texas Department of State Health Services Publications Catalog-by Language
Publications Management Program - 86
Electronic File
E58-11040
Birth Defects Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E4-25-alpha
Texas Department of State Health Services Publications Catalog-by Alphabetical Listing
Publications Management Program - 86
Electronic File
E4-20-8
Alzheimer's Disease, Aging, Long Term Care, Infection Control, Fire Safety, Back Safety
Audiovisual Library - 196
Electronic File
ED-1
Health Media Order Blank - Audiovisual Library
Audiovisual Library - 378
Electronic File
E4-25-contact
Texas Department of State Health Services Publications CatalogContact Information
Publications Management Program - 86
Electronic File
E4-25-format
Texas Department of State Health Services Publications Catalog-by Format
Publications Management Program - 86
Electronic File
E4-25-subject
Texas Department of State Health Services Publications Catalog-by Subject Heading
Publications Management Program - 86
Electronic File
E4-20-12
Home Health Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E4-23
Emergency Medical Services (EMS) Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E4-25-ordering
Texas Department of State Health Services Publications CatalogOrdering Instructions
Publications Management Program - 86
Electronic File
E4-20-16
Occupational Health & Safety/Back Safety/Infection Control Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E4-20-13
AIDS/Hepatitis/Sexually Transmitted Diseases/Tuberculosis Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E4-21
DSHS Staff Development Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E4-20-17
Smoking and Smokeless Tobacco Audiovisual Catalog
Audiovisual Library - 196
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 85 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E4-20-19
Automobile Safety Mini-catalog
Audiovisual Library - 196
Electronic File
E4-20-4
Minority Health Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E4-20-5
Spanish Language Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E4-20
Health Media Catalog
Audiovisual Library - 196
Electronic File
Health Statistics / Estadisticas de salud E25-12041
Migration Trends: Texas RN and LVN Workforce
TX Ctr Nursing Workforce - 673
Electronic File
E25-12095
Reports on Nursing Workforce and Nursing Education (October, 2004)
Ctr for Health Statistics 181
Electronic File
E25-12096
Executive Summaries of Reports on Nursing Workforce and Nursing Education (October, 2004)
Ctr for Health Statistics 181
Electronic File
E25-12112
Texas Registered Nurse Hospital Staffing Survey
TX Ctr Nursing Workforce - 673
Electronic File
E25-12225
Increasing RN Graduates: Admission, Progression, and Graduation in Texas Schools of Nursing
TX Ctr Nursing Workforce - 673
Electronic File
E25-12347
Highlights of "The Supply of Mental Health Professionals in Texas"
Hlth Prof Resource Ctr 662
Electronic File
E25-12400
A Workforce Study of Medical, Nursing and Mental Health Professions in Texas
Hlth Prof Resource Ctr 661
Electronic File
E25-12353
Highlights: The Supply of Pharmacists in Texas
Hlth Prof Resource Ctr 662
Electronic File
E25-12040
Demographics and Trends in Nursing Education in Texas
TX Ctr Nursing Workforce - 673
Electronic File
E25-12039
Texas Sources for Nursing Supply Data
Ctr for Health Statistics 181
Electronic File
E25-11994
Demographics of the Nursing Workforce Texas - 2003
TX Ctr Nursing Workforce - 673
Electronic File
E25-11847
Supply Trends Among Licensed Health Professions, Texas
Hlth Prof Resource Ctr 767
Electronic File
E25-11420
Healthy People 2000 Health Status Indicators by Texas Public Health Regions
Center for Health Statistics - 477
Electronic File
E25-11399
The State of Telemedicine and Telehealth in Texas
Statewide Health Electronic File Coordinating Council - 666
E25-11033
Texas Health Facts
Center for Health Statistics - 191
Electronic File
E25-12512
Texas Hospital Nurse Staffing Survey (2006)-Executive Summary and Recommendation
TX Ctr Nursing Workforce - 673
Electronic File
E25-10992
Selected Health Professions in Texas
Hlth Prof Resource Ctr 662
Electronic File
E25-12451
THCIC Hospital Certifications Manual Version 1.0
Tx Hlth Care Info Collection - 649
Electronic File
E25-10990
Aging Texas Well 1999: A Health Perspective
Prog Coord, Policy & Innov - 101
Electronic File
E25-11019
Selected Demographic and Public Health Measures: Rankings for Texas Counties
Center for Health Statistics - 665
Electronic File
E25-12452
THCIC Hospital Data Corrections Manual Version 1.0
Tx Hlth Care Info Collection - 649
Electronic File
E09-13143
2006 Texas Cause of Injury Profiles by Trauma Service Areas as Reported by EMS Providers
Epidemiology/Injury Surveillance - 516
Electronic File
E25-10956
Migration for Birth
Center for Health Statistics - 188
Electronic File
E25-12508
The Feminization of the Health Care Workforce: Implications for Texas
Hlth Prof Resource Ctr 662
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 86 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E25-12505
Highlights: The Supply of Registered Nurses in Texas - 2005
TX Ctr Nursing Workforce - 673
E25-12504
Texas State Health Plan Update 2007-2008
Statewide Health Electronic File Coordinating Council - 172
E25-12501
Recruitment and Retention of Health Care Providers in Underserved Communities in Texas
Hlth Prof Resource Ctr 662
Electronic File
E25-12511
Texas Hospital Nurse Staffing Survey (2006)
TX Ctr Nursing Workforce - 673
Electronic File
E25-12449
THCIC 837 Claim-Technical Discussion (Creating Data in THCIC 8317-Discussion Notes)
Tx Hlth Care Info Collection - 649
Electronic File
E25-12453
Hospital Discharge Data Collection THCIC 837 Technical Specifications Ver 15
Tx Hlth Care Info Collection - 649
Electronic File
E25-12401
Texas Health Care Workforce Supply Trends
Hlth Prof Resource Ctr 661
Electronic File
E25-12450
THCIC Audit List
Tx Hlth Care Info Collection - 649
Electronic File
E25-12448
Texas Subset of HEDIS 2007
Tx Hlth Care Info Collection - 647
Electronic File
E25-12445
Hospital Listings
Tx Hlth Care Info Collection - 649
Electronic File
E25-12440
Exemption for HEDIS Reporting (Critieria)
Tx Hlth Care Info Collection - 647
Electronic File
E25-12437
Indicators of Inpatient Care in Texas Hospitals, 2004
Tx Hlth Care Info Collection - 723
Electronic File
E25-12436
Indicators of Inpatient Care in Texas Hospitals, 2003
Tx Hlth Care Info Collection - 648
Electronic File
E25-12435
Commercial Product Basic Service HMOs
Tx Hlth Care Info Collection - 647
Electronic File
E25-12420
Highlights: The Supply of Primary Care Physicians in Texas - 2005
Hlth Prof Resource Ctr 662
Electronic File
E25-12455
THCIC Hospital HyperTerminal Setup Manual Version 1.0
Tx Hlth Care Info Collection - 649
Electronic File
DSHSIRBF103
Institutional Review Board Final Report Upon Termination of Project Form
Center for Health Statistics - 551
Electronic File
E09-12401
Injury Surveillance Brief Series: Drownings in Texas
Epidemiology/Injury Surveillance - 516
Electronic File
E09-12356
Protocol for Receipt and Queuing of External Data Requests
Epidemiology/Injury Surveillance - 516
Electronic File
E05-12577
Texas Child Fatality Review Team Post
Title V-Child Fatality Review - 691
Electronic File
DSHSIRBF109
Institutional Review Board Language Use Worksheet
Center for Health Statistics - 551
Electronic File
DSHSIRBF108
Institutional Review Board Consent Document Checklist
Center for Health Statistics - 551
Electronic File
DSHSIRBF1072
Institutional Review Board Consent Document Guidelines
Center for Health Statistics - 551
Electronic File
DSHSIRBF106
Institutional Review Board Consent Document Example
Center for Health Statistics - 551
Electronic File
E09-13260
Top 5 Causes of Injury Hospitalization by TSA
Prevention & Preparedness - 829
Electronic File
DSHSIRBF104
Institutional Review Board Assent Document Example
Center for Health Statistics - 551
Electronic File
E09-13259
Top 5 Causes of Injury Death, Disability, and Hospital Charges in Texas v2
Prevention & Preparedness - 829
Electronic File
DSHSIRBF102
Institutional Review Board Request for Expedited Review of Research Form
Center for Health Statistics - 551
Electronic File
Stock #4-25-lang Revised 10/25/2010
Electronic File
Page 87 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
DSHSIRBF101
Institutional Review Board Request for Exemption from Review of Research Form
Center for Health Statistics - 551
Electronic File
DSHSIRBF100
Institutional Review Board Application Form
Center for Health Statistics - 551
Electronic File
BirthDefects95
Report of Birth Defects Among 1995 Deliveries
Birth Defects Epi - 210
Electronic File
56-12494
Epi Review
HSR 9/10-ERT - 658
Newsletters
35-12604
The Vital Statistics Review
Vital Statistics - 756
Newsletters
E25-12513
Supply of and Demand for Registered Nurses and Nurse Graduates in Texas:Report to 80th Legislature
TX Ctr Nursing Workforce - 673
Electronic File
E25-12470
The Cost of Cancer in Texas
Tx Hlth Care Info Collection - 301
Electronic File
DSHSIRBF105
Institutional Review Board Assent Document Guidelines
Center for Health Statistics - 551
Electronic File
E09-MB03LV
Top Five Causes of Injury-related Hospitalizations: RACs L-V 2003
Epidemiology/Injury Surveillance - 516
Electronic File
E10-13121
The Cost of Cancer in Texas, 2007
Cancer Epi/Surv - 111
Electronic File
E10-12820
Cancer Incidence & Mortality in Texas, 1999-2003
Cancer Epi/Surv - 111
Electronic File
E10-12424
SANDCRAB Lite for Pathlabs User's Manual (restricted to SANDCRAB users)
Cancer Epi/Surv - 636
Electronic File
E10-11701
Commonly Used Variables from the Texas Cancer Registry
Cancer Epi/Surv - 369
Electronic File
E09-MT04LV
Mortality in Trauma Service Area by Cause: RACs L-V 2004
Epidemiology/Injury Surveillance - 516
Electronic File
E09-MT04AK
Mortality in Trauma Service Area by Cause: RACs A-K 2004
Epidemiology/Injury Surveillance - 516
Electronic File
E09-MT03LV
Mortality in Trauma Service Area by Cause: RACs L-V 2003
Epidemiology/Injury Surveillance - 516
Electronic File
E09-MT03AK
Mortality in Trauma Service Area by Cause: RACs A-K 2003
Epidemiology/Injury Surveillance - 516
Electronic File
E09-12945
The Top 5 Causes of Death, Disability, and Hospital Charges Due to Injury
Epidemiology/Injury Surveillance - 516
Electronic File
E09-MB04AK
Top Five Causes of Injury-related Hospitalizations: RACs A-K 2004
Epidemiology/Injury Surveillance - 516
Electronic File
E09-13142
2006 Texas Cause of Injury Profiles by Trauma Service Areas as Reported by Hospitals
Epidemiology/Injury Surveillance - 516
Electronic File
E09-MB03AK
Top Five Causes of Injury-related Hospitalizations: RACs A-K 2003
Epidemiology/Injury Surveillance - 516
Electronic File
E09-13450
Non-fatal Injury Hospitalizations by TSA-2008 (Texas)
Prevention & Preparedness - 829
Electronic File
E09-13449
Non-fatal Injury Hospitalizations by TSA-2007 (Texas)
Prevention & Preparedness - 829
Electronic File
E09-13448
Non-fatal Injury Hospitalizations by TSA-2006 (Texas)
Prevention & Preparedness - 829
Electronic File
E09-13447
Non-fatal Injury Hospitalizations by TSA-2005 (Texas)
Prevention & Preparedness - 829
Electronic File
E09-13446
Non-fatal Injury Hospitalizations by TSA-2004 (Texas)
Prevention & Preparedness - 829
Electronic File
E09-13264
Submersions in Texas, 2008
Prevention & Preparedness - 829
Electronic File
E10-13294
Cancer in Texas, 2009
Cancer Epi/Surv - 833
Electronic File
E09-MB04LV
Top Five Causes of Injury-related Hospitalizations: RACs L-V 2004
Epidemiology/Injury Surveillance - 516
Electronic File
E25-13269
Public Health Brief 4. Vacancies in Federally Qualified Health Centers
Hlth Prof Resource Ctr 715
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 88 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E25-13117
2008 Update on Student Demographics in Professional Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13383
2009 Update on Faculty Demographics in Vocational Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13382
2009 Update on Vocational Nursing Program Characteristics
TX Ctr Nursing Workforce - 673
Electronic File
E25-13381
2009 Update on Student Admission, Enrollment, and Graduation Trends in Vocational Nursing Program
TX Ctr Nursing Workforce - 673
Electronic File
E25-13380
2009 Update on Student Demographics in Professional Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13379
2009 Update on Student Admission, Enrollment, and Graduation Trends in Professional Nursing Program
TX Ctr Nursing Workforce - 673
Electronic File
E25-13378
2009 Update on Professional Nursing Program Characteristics
TX Ctr Nursing Workforce - 673
Electronic File
E25-13377
2009 Update on Faculty Demographics in Professional Nursing Program
TX Ctr Nursing Workforce - 673
Electronic File
E25-13362
Texas Fact Sheet: Texas Psyciatric Hospitals Fact Sheet - 2008
Hlth Prof Resource Ctr 769
Electronic File
E25-13361
Texas Fact Sheet: Texas Acute Care Hospitals Fact Sheet - 2008
Hlth Prof Resource Ctr 769
Electronic File
E25-13272
Public Health in Texas. The Public Health Workforce - Federally Qualified Health Centers
Hlth Prof Resource Ctr 715
Electronic File
E25-13385
2009 Educational Pipelines for Nurses in Texas
TX Ctr Nursing Workforce - 673
Electronic File
E25-13270
Public Health Brief 5. Additional Workers Needed in Federally Qualified Health Centers
Hlth Prof Resource Ctr 715
Electronic File
E25-13433
A Guide to Workforce Data on Mental Health Professions
Hlth Prof Resource Ctr 662
Electronic File
E25-13268
Public Health Brief 3. Staffing Levels in Federally Qualified Health Centers
Hlth Prof Resource Ctr 715
Electronic File
E25-13267
Public Health Brief 2. Providers in Federally Qualified Health Centers
Hlth Prof Resource Ctr 715
Electronic File
E25-13266
Public Health Brief 1. Functions in Federally Qualified Health Centers
Hlth Prof Resource Ctr 715
Electronic File
E25-13171
2008 Update on Faculty Demographics in Vocational Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13151
2008 Update on Vocational Nursing Program Characteristics
TX Ctr Nursing Workforce - 673
Electronic File
E25-13150
2008 Update on Graduate Demographics from Vocational Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13149
2008 Update on Student Admission, Enrollment and Graduation Trends in Vocational Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13145
The Supply of Pediatricians in Texas - 2008
Hlth Prof Resource Ctr 715
Electronic File
E25-13131
Texas Fact Sheet: Texas Acute Care Hospitals Fact Sheet - 2007
Hlth Prof Resource Ctr 769
Electronic File
E25-13130
Texas Fact Sheet: Texas Psychiatric Hospitals Fact Sheet - 2007
Hlth Prof Resource Ctr 769
Electronic File
E25-13119
2008 Update on Professional Nursing Program Characteristics
TX Ctr Nursing Workforce - 673
Electronic File
E25-13118
2008 Update on Faculty Demographics in Professional Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13271
Public Health Brief 6. Spotlight on Workers by Public Health Regions in Federally Qualified Health
Hlth Prof Resource Ctr 715
Electronic File
E58-12507
Birth Defects in Top 20 Counties
Birth Defects Epi - 169
Electronic File
RioGran96
1996 Birth Defects in the Lower Rio Grande Valley-A Special Report
Birth Defects Epi - 210
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 89 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Hosp-
Listing of Texas Acute and Psychiatric Hospitals
Center for Health Statistics - 397
Electronic File
F25-11047
Annual Statement of Community Benefits Standard
SHCC - 23
Forms
F25-11006
Annual Survey of Hospitals
Center for Health Statistics - 257
Forms
EF25-12456
Update Information About Your Hospital
Tx Hlth Care Info Collection - 649
Electronic File
EF25-11047
Annual Statement of Community Benefits Standard
Center for Health Statistics - 476
Electronic File
EF25-11006
Annual Survey of Hospitals
Center for Health Statistics - 397
Electronic File
E90-11515
Health of Texans: Texas State Strategic Health Plan Part I-Executive Summary
Prog Coord, Policy & Innov - 101
Electronic File
E90-11514
Health of Texans: Texas State Strategic Health Plan Part I
Prog Coord, Policy & Innov - 101
Electronic File
E88-11695
The Declaration for Health: Texas State Strategic Health Plan, Part III
Prog Coord, Policy & Innov - 101
Electronic File
E88-11513
Public Health Improvement Plan
Prog Coord, Policy & Innov - 101
Electronic File
E25-13384
2009 Update on Vocational Nursing Student Demographics
TX Ctr Nursing Workforce - 673
Electronic File
E59-12544
The EpiLink Online Bulletin
Infectious Disease - 725
Electronic Newsletter/Magazine
E58-10772
Report of Birth Defects Among 1996-1997 Deliveries
Birth Defects Epi - 210
Electronic File
E25-12454
Hospital Discharge Data Collection Hospital Procedures & Technical Specifications Appendicies Ver 14
Tx Hlth Care Info Collection - 649
Electronic File
E25-12514
Supply of and Demand for Registered Nurses and Nurse Graduates in Texas: Executive Summary/Recommend
TX Ctr Nursing Workforce - 673
Electronic File
E58-12309
Report of Birth Defects among 1999-2002 Deliveries
Birth Defects Epi - 210
Electronic File
E58-11857
Report of Birth Defects Among 1999-2000 Deliveries
Birth Defects Epi - 210
Electronic File
E56-12494
Epi Review
HSR 9/10-ERT - 659
Electronic Newsletter/Magazine
E54-12596
Epidemiology and Surveillance Quarterly Newsletter
HSR 7- Epidemiology - 696 Electronic Newsletter/Magazine
E4-187
Strategic Plan
Prog Coord, Policy & Innov- 785
Electronic File
E35-12604
The Vital Statistics Review
Vital Statistics - 757
Electronic Newsletter/Magazine
E25-13481
2011-2016 Texas State Health Plan-Executive Summary--A Roadmap to a Healthy Texas
Statewide Health Electronic File Coordinating Council - 172
E25-13480
2011-2016 Texas State Health Plan-A Roadmap to a Healthy Texas
Statewide Health Electronic File Coordinating Council - 172
E25-13435
Characteristics of New Physicians in Texas: 2000-2009
Hlth Prof Resource Ctr 662
Electronic File
E25-13434
A Guide for Data and Career Information on Registered Nurses
Hlth Prof Resource Ctr 662
Electronic File
E6-240
Report of Birth Defects among 1999-2001 Deliveries
Birth Defects Epi - 210
Electronic File
E25-12515
Highlights: The Economic Impact of the Nursing Shortage
TX Ctr Nursing Workforce - 673
Electronic File
E25-12943
Public Health in Texas: The Public Health Workforce-Local Health Departments (part 1)
Hlth Prof Resource Ctr 766
Electronic File
E25-12942
Public Health Brief 7: Spotlight on Workers in Public Health Regions in Local Health Depts (part 1)
Hlth Prof Resource Ctr 766
Electronic File
E25-12941
Public Health Brief 6: Preventative Medicine Physicians in Local Health Departments (part 1)
Hlth Prof Resource Ctr 766
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 90 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E25-12940
Public Health Brief 5: Additional Budgeted Workers Needed in Local Health Departments (part 1)
Hlth Prof Resource Ctr 766
Electronic File
E25-12939
Public Health Brief 4: Staff Vacancies in Local Health Departments (part 1)
Hlth Prof Resource Ctr 766
Electronic File
E25-12518
Highlights: Recruitment and Retention of Nurses in the Workforce
TX Ctr Nursing Workforce - 673
Electronic File
E25-12938
Public Health Brief 3: Staff Levels in Local Health Departments (part 1)
Hlth Prof Resource Ctr 766
Electronic File
E25-12519
Highlights: Recruitment and Retention of Nursing Faculty
TX Ctr Nursing Workforce - 673
Electronic File
E25-12937
Public Health Brief 2: Providers in Local Health Departments (part 1)
Hlth Prof Resource Ctr 766
Electronic File
E25-12516
Highlights: Internationally Educated Nurses in Texas
TX Ctr Nursing Workforce - 673
Electronic File
E25-12936
Public Health Brief 1: Functions in Local Health Departments (part 1)
Hlth Prof Resource Ctr 766
Electronic File
E25-13025
2007 Update on Student Admission, Enrollment, and Graduation Trends in Professional Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-12916
THCIC Data Collection, Outpatient THCIC 837 Technical Specifications
Tx Hlth Care Info Collection - 755
Electronic File
E25-13026
2007 Update on Professional Nursing Programs: Resources Needed to Increase Capacity, Geographic Loca
TX Ctr Nursing Workforce - 673
Electronic File
E25-12901
Promoting Excellence Through Healthcare Workforce Planning in Texas - 2007
Hlth Prof Resource Ctr 662
Electronic File
E25-12521
Highlights: 2006 Expansion of Beds Survey
TX Ctr Nursing Workforce - 673
Electronic File
E25-12522
Highlights: Texas Hospital Nurse Staffing Survey (2006)
TX Ctr Nursing Workforce - 673
Electronic File
E25-12528
Highlights: The Supply of and Demand for Registered Nurses and Nurse Graduates in Texas: Rpt to Leg
TX Ctr Nursing Workforce - 673
Electronic File
E25-12529
Highlights: White Paper Briefs on Major Nursing Workforce Issues
TX Ctr Nursing Workforce - 673
Electronic File
E25-12556
Highlights: The Supply of Physician Assistants in Texas - 2006
Hlth Prof Resource Ctr 662
Electronic File
E25-12581
Highlights: The Supply of General Dentists in Texas - 2006
Hlth Prof Resource Ctr 662
Electronic File
E25-12830
Professional Nursing Education in Texas-Demographics and Trends: 2006
TX Ctr Nursing Workforce - 673
Electronic File
E25-12778
Highlights: The Supply of Pediatricians in Texas - 2006
E25-12779
Health Professions Resource Center: Your Source for Health Provider Data
Hlth Prof Resource Ctr 715
Electronic File
E25-13116
2008 Update on Student Admission, Enrollment and Graduation Trends in Professional Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-12841
Professional Nursing Education in Texas - Demographics & Trends: 2006 Executive Summary
TX Ctr Nursing Workforce - 673
Electronic File
E25-12520
Highlights: Admission, Enrollment and Graduation Trends in Initial RN Licensure Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13051
Vocational Nursing (VN) Programs: 2007 Faculty Demographics
TX Ctr Nursing Workforce - 673
Electronic File
E25-13094
Summary of Texas Public Health Professional Staffing Levels
Hlth Prof Resource Ctr 715
Electronic File
E25-13093
Public Health Brief 4. Spotlight on Workers by Public Health Regions in the Health and Human Service
Hlth Prof Resource Ctr 715
Electronic File
E25-13092
Public Health Brief 3. Vacancies in the Health and Human Services Enterprise
Hlth Prof Resource Ctr 715
Electronic File
Stock #4-25-lang Revised 10/25/2010
Electronic File
Page 91 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E25-13091
Public Health Brief 2. Providers in the Health and Human Services Enterprise
Hlth Prof Resource Ctr 715
Electronic File
E25-13090
Public Health Brief 1. Staffing Levels in the Health and Human Services Enterprise
Hlth Prof Resource Ctr 715
Electronic File
E25-13089
Public Health in Texas: The Public Health Workforce-Health and Human Services Enterprise
Hlth Prof Resource Ctr 715
Electronic File
E25-13088
Physician Acceptance of Medicaid Patients in Texas
Hlth Prof Resource Ctr 715
Electronic File
E25-13086
Texas Center for Nursing Workforce Studies: 2008 Report
TX Ctr Nursing Workforce - 673
Electronic File
E25-13076
2009-2010 Texas State Health Plan Update
Statewide Health Electronic File Coordinating Council - 172
E25-13064
2008 Long Term Care Nurse Staffing Survey Highlights of Findings and Recommendations
TX Ctr Nursing Workforce - 673
Electronic File
E25-13063
2008 Hospital Nurse Staffing Survey Highlights of Findings and Recommendations
TX Ctr Nursing Workforce - 673
Electronic File
E25-13054
Fact Sheet: 2008 Hospital Nurse Staffing Survey (HNSS) Vacancy and Turnover Rates
TX Ctr Nursing Workforce - 673
Electronic File
E25-12944
Texas Fact Sheet: Texas Psychiatric Hospitals Fact Sheet - 2006
Hlth Prof Resource Ctr 769
Electronic File
E25-13052
Vocational Nursing (VN) Programs: 2007 Geographic Location, Length of Curriculum, and Resources Need
TX Ctr Nursing Workforce - 673
Electronic File
E25-13050
Vocational Nursing (VN) Programs: 2007 Student Admission, Enrollment, Graduation, and Student Demogr
TX Ctr Nursing Workforce - 673
Electronic File
E25-13049
Turnover and Vacancy Rates in Texas Long Term Care Nursing Faciliites for Unlicensed Nursing Staff
TX Ctr Nursing Workforce - 673
Electronic File
E25-13048
Turnover and Vacancy Rates in Texas Long Term Care Nursing Faciliites for RNs and LVNs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13047
2008 Long Term Care Nurse Staffing Study (LTC NSS) Study Design and Methods
TX Ctr Nursing Workforce - 673
Electronic File
E25-13046
Staff Compensation and Benefits in Texas Long Term Care Nursing Faciliites
TX Ctr Nursing Workforce - 673
Electronic File
E25-13045
Safe Patient Handling in Texas Long Term Care Nursing Facilities
TX Ctr Nursing Workforce - 673
Electronic File
E25-13044
2008 Hospital Nurse Staffing Survey (HNSS) Methods of Interim Staffing of Registered Nurses
TX Ctr Nursing Workforce - 673
Electronic File
E25-13043
Directors of Nursing (DON) in Texas Long Term Care Nursing Facilities
TX Ctr Nursing Workforce - 673
Electronic File
E25-13028
2007 Update on Student Demographics in Professional Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13027
2007 Update on Faculty Demographics in Professional Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-12517
Highlights: Strategies to Retain Older, Experienced Nurses in the Workforce
TX Ctr Nursing Workforce - 673
Electronic File
E25-13053
Fact Sheet: 2008 Hospital Nurse Staffing Survey (HNSS) Expansion of Beds
TX Ctr Nursing Workforce - 673
Electronic File
Heart Disease & Hypertension / Enfermedad cardiaca e Hipertension E81-10930
Texas Cardiovascular Disease and Stroke Council Legislative Report
Cardiovascular Health and Wellness - 193
Electronic File
E10-15C
ABCs of Health - Cholesterol
Adult Health - 231
Electronic File
E10-15F
ABCs of Health - High Blood Pressure
Adult Health - 231
Electronic File
E45-11267
Hypertension Algorithm for Diabetes Mellitus in Adults
Texas Diabetes Council 197
Electronic File
F74-10755
Licensed Perfusionist or Provisional Licensed Perfusionist
Tx State Bd of Examiners of Perfusionists - 135
Forms
Stock #4-25-lang Revised 10/25/2010
Page 92 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E81-11194
Texas Chronic Disease Burden Report
Chronic Disease - 859
Electronic File
E81-11195
Texas Plan to Reduce Cardiovascular Disease and Stroke
Cardiovascular Health and Wellness - 193
Electronic File
E81-11271
Cardiovascular Disease in Texas Poster
Cardiovascular Health and Wellness - 233
Electronic File
E44-13436
Stroke Public Education Campaign Toolkit
Texas CVD/Stroke - 874
Electronic File
Hemophilia / Hemofilia E41-11996
Hemophilia Assistance Program Rules
Hemophilia Assistance 404
Electronic File
F41-11839
Hemophilia Assistance Program-Covered Products, Allowable Fees, Limitations & Requirements
Hemophilia Assistance 403
Forms
EF41-11838
Hemophilia Assistance Program - Fact Sheet
Hemophilia Assistance 404
Electronic File
F41-11838
Hemophilia Assistance Program - Fact Sheet
Hemophilia Assistance 403
Forms
EF41-11811
Hemophilia Assistance Program - Application for Assistance (Adults over 21)
Hemophilia Assistance 404
Electronic File
F41-11811
Hemophilia Assistance Program - Application for Assistance (Adults over 21)
Hemophilia Assistance 403
Forms
EF41-11839
Hemophilia Assistance Program-Covered Products, Allowable Fees, Limitations & Requirements
Hemophilia Assistance 404
Electronic File
Perinatal Hepatitis B Manual
Infectious Disease - 683
Electronic File
E59-11529
Hep C At-Risk Adult
Infectious Disease - 533
Electronic File
E59-12547
Health Care Provider Brochure
Infectious Disease - 683
Electronic File
E59-11686
Hepatitis C Action Plan (December 2002)
Infectious Disease - 363
Electronic File
E59-11528
If you Have Hep C, Get Vaccinated Against Hep A & B
Infectious Disease - 533
Electronic File
E6-12P
Know Hepatitis C: Know the Facts, Not the Fears
Infectious Disease - 533
Electronic File
E6-315P
Sharing Needles is Risky, Don't Get Stuck with Hepatitis C
Infectious Disease - 533
Electronic File
E6-316P
If you Have Hep C, Get Vaccinated Against Hep A & B
Infectious Disease - 533
Electronic File
E6-34
Pregnancy, Hepatitis B and Rubella Facts (If you are pregnant..)
Immunization - 151
Electronic File
EC-106
Hepatitis B Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
EC-95
Hepatitis A Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
EF11-10866
Acute Hepatitis B Case Track Record
Infectious Disease - 727
Electronic File
EF11-10931
Infant Summary Report for Perinatal Hepatitis B Prevention
Infectious Disease - 668
Electronic File
EF11-10934
Contact Summary Report for Perinatal Hepatitis B Prevention
Infectious Disease - 668
Electronic File
EF11-11014
Physician's Prenatal Report HBsAg-Positive Mother
Infectious Disease - 668
Electronic File
EF11-11015
Hospital Delivery Report of HBsAg-Positive Mother
Infectious Disease - 668
Electronic File
EF11-11539
Perinatal HBsAg Status Card
Perinatal Hepatitis B - 750
Electronic File
EF59-12350
Summary Report for Perinatal and Infant Hepatitis C
Infectious Disease - 611
Electronic File
TCADA-27
Sexually Transmitted Diseases and Hepatitis B and C in Three Drug Abuse Clinics in Texas
Mental Hlth/Sub Abuse 488
Electronic File
E13-11894
Hepatitis C Fact Sheet
HIV/STD - 449
Electronic File
EF11-10932
Mother Summary Report for Perinatal Hepatitis B Prevention
Infectious Disease - 668
Electronic File
59-13391P
Perinatal Hepatitis B Parent Poster
Immunization - 293
Posters
E13-11896
Hepatitis E Fact Sheet
HIV/STD - 449
Electronic File
Hepatitis / Hepatitis E59-12818
Stock #4-25-lang Revised 10/25/2010
Page 93 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
59-13390P
Perinatal Hepatitis B Provider Poster
Immunization - 293
Posters
E59-11527
Hep C At-Risk Youth
Infectious Disease - 533
Electronic File
6-12P
Know Hepatitis C: Know the Facts, Not the Fears (Limit 20)
Warehouse
Posters
6-315P
Sharing Needles is Risky, Don't Get Stuck with Hepatitis C
Warehouse
Posters
C-106
Hepatitis B Vaccine-What You Need to Know (Limit 200)
Immunization - 710
Forms
C-95
Hepatitis A Vaccine-What You Need to Know
Immunization - 710
Forms
E11-11444
Client Brochure (Perinatal Hepatitis B)
TB Elimination - 855
Electronic File
E11-12047
The Importance of Childhood Hepatitis B Immunizations (White Paper)
Immunization - 480
Electronic File
E13-11892
Hepatitis A Fact Sheet
HIV/STD - 449
Electronic File
E13-11893
Hepatitis B Fact Sheet
HIV/STD - 449
Electronic File
E13-11895
Hepatitis D Fact Sheet
HIV/STD - 449
Electronic File
E59-11319
Hepatitis B Fact Sheet
Infectious Disease - 623
Electronic File
E13-11908
The Risk of Eating Raw Oysters Fact Sheet
HIV/STD - 449
Fact Sheets
E59-11322
Hepatitis G Fact Sheet
Infectious Disease - 623
Electronic File
E59-11320
Hepatitis D Fact Sheet
Infectious Disease - 623
Electronic File
E59-11317
Hepatitis Fact Sheet
Infectious Disease - 623
Electronic File
E59-11278
Sharing Needles is Risky, Don't Get Stuck with Hepatitis C
Infectious Disease - 533
Electronic File
E4-20-13
AIDS/Hepatitis/Sexually Transmitted Diseases/Tuberculosis Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E23-13191
FEGRC - No. 5: Food Employee Infected with Hepatitis C Virus
Food Establishments - 811
Electronic File
E13-13263
HIV, Syphilis and Hepatitis B Testing for Pregnant Women
HIV/STD - 783
Electronic File
E13-13113
HCV in Texas
HIV/STD - 783
Electronic File
E13-13033
Syringe Exchange as HIV and Hepatits Prevention
HIV/STD - 783
Electronic File
E13-13354
The Decline of Hepatitis A and B Cases in Texas
HIV/STD - 332
Electronic File
E59-11321
Hepatitis E Fact Sheet
Infectious Disease - 623
Electronic File
Hospitals / Hospitales E25-12511
Texas Hospital Nurse Staffing Survey (2006)
TX Ctr Nursing Workforce - 673
Electronic File
E25-13063
2008 Hospital Nurse Staffing Survey Highlights of Findings and Recommendations
TX Ctr Nursing Workforce - 673
Electronic File
E25-13054
Fact Sheet: 2008 Hospital Nurse Staffing Survey (HNSS) Vacancy and Turnover Rates
TX Ctr Nursing Workforce - 673
Electronic File
E25-13053
Fact Sheet: 2008 Hospital Nurse Staffing Survey (HNSS) Expansion of Beds
TX Ctr Nursing Workforce - 673
Electronic File
E25-13044
2008 Hospital Nurse Staffing Survey (HNSS) Methods of Interim Staffing of Registered Nurses
TX Ctr Nursing Workforce - 673
Electronic File
E25-12944
Texas Fact Sheet: Texas Psychiatric Hospitals Fact Sheet - 2006
Hlth Prof Resource Ctr 769
Electronic File
E25-12522
Highlights: Texas Hospital Nurse Staffing Survey (2006)
TX Ctr Nursing Workforce - 673
Electronic File
E25-12466
THCIC Hospital Submitter / Provider Enrollment Manual Version 1.0
Tx Hlth Care Info Collection - 649
Electronic File
E25-12512
Texas Hospital Nurse Staffing Survey (2006)-Executive Summary and Recommendation
TX Ctr Nursing Workforce - 673
Electronic File
E25-13130
Texas Fact Sheet: Texas Psychiatric Hospitals Fact Sheet - 2007
Hlth Prof Resource Ctr 769
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 94 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E25-12467
THCIC Secured Server Procedures Manual Version 1.0
Tx Hlth Care Info Collection - 649
Electronic File
EF25-12456
Update Information About Your Hospital
Tx Hlth Care Info Collection - 649
Electronic File
E25-12471
Utilization of Specific Inpatient Procedures by Texas Hospital Referral Region
Tx Hlth Care Info Collection - 301
Electronic File
E25-12521
Highlights: 2006 Expansion of Beds Survey
TX Ctr Nursing Workforce - 673
Electronic File
E25-13131
Texas Fact Sheet: Texas Acute Care Hospitals Fact Sheet - 2007
Hlth Prof Resource Ctr 769
Electronic File
E25-13361
Texas Fact Sheet: Texas Acute Care Hospitals Fact Sheet - 2008
Hlth Prof Resource Ctr 769
Electronic File
E25-13362
Texas Fact Sheet: Texas Psyciatric Hospitals Fact Sheet - 2008
Hlth Prof Resource Ctr 769
Electronic File
E59-12154
Guidelines for Preventing Spread of Multi-Drug Resistant Bacteria/Health Care Setting
Infectious Disease - 400
Electronic File
E87-11648
Hospitalization in Texas, 2001
Tx Hlth Care Info Collection - 301
Electronic File
F25-11047
Annual Statement of Community Benefits Standard
SHCC - 23
Forms
EF25-11047
Annual Statement of Community Benefits Standard
Center for Health Statistics - 476
Electronic File
EF25-12466
Research Data Dictionary; Research Data Use Agreement; Research Data Request Form
Tx Hlth Care Info Collection - 407
Electronic File
EMH-9
The Little Dinosaur Named Wilbur (Bill of Rights for Children)
Mental Hlth-Substance Abuse - 670
Electronic File
F25-11006
Annual Survey of Hospitals
Center for Health Statistics - 257
Forms
Hosp-
Listing of Texas Acute and Psychiatric Hospitals
Center for Health Statistics - 397
Electronic File
E25-12454
Hospital Discharge Data Collection Hospital Procedures & Technical Specifications Appendicies Ver 14
Tx Hlth Care Info Collection - 649
Electronic File
E25-12465
THCIC Hospital Numbered Letters Volume 9
Tx Hlth Care Info Collection - 724
Electronic File
EF25-11006
Annual Survey of Hospitals
Center for Health Statistics - 397
Electronic File
40-11084
TCID Round-up Newsletter
Texas Center for Infectious Disease - 200
Newsletters
E25-12464
THCIC Hospital Numbered Letters Volume 8
Tx Hlth Care Info Collection - 724
Electronic File
E25-12457
THCIC Hospital Numbered Letters Volume 1
Tx Hlth Care Info Collection - 724
Electronic File
13-06-11178
Texas Ten Step Hospitals (Restricted to WIC local agencies)
Posters
E09-12945
The Top 5 Causes of Death, Disability, and Hospital Charges Due to Injury
Epidemiology/Injury Surveillance - 516
E09-13260
Top 5 Causes of Injury Hospitalization by TSA
Prevention & Preparedness - 829
Electronic File
E09-MB03AK
Top Five Causes of Injury-related Hospitalizations: RACs A-K 2003
Epidemiology/Injury Surveillance - 516
Electronic File
E09-MB03LV
Top Five Causes of Injury-related Hospitalizations: RACs L-V 2003
Epidemiology/Injury Surveillance - 516
Electronic File
E09-MB04AK
Top Five Causes of Injury-related Hospitalizations: RACs A-K 2004
Epidemiology/Injury Surveillance - 516
Electronic File
E09-MB04LV
Top Five Causes of Injury-related Hospitalizations: RACs L-V 2004
Epidemiology/Injury Surveillance - 516
Electronic File
E25-12112
Texas Registered Nurse Hospital Staffing Survey
TX Ctr Nursing Workforce - 673
Electronic File
Stock #4-25-lang Revised 10/25/2010
Electronic File
Page 95 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E25-12442
Indicators of Inpatient Care in Texas Hospitals, 2004
Tx Hlth Care Info Collection - 301
Electronic File
E25-12444
Public Use Data File User Manual; PUDF Data Use Agreement; PUDF Order Form
Tx Hlth Care Info Collection - 407
Electronic File
E25-12445
Hospital Listings
Tx Hlth Care Info Collection - 649
Electronic File
E25-12461
THCIC Hospital Numbered Letters Volume 5
Tx Hlth Care Info Collection - 724
Electronic File
E25-12450
THCIC Audit List
Tx Hlth Care Info Collection - 649
Electronic File
E25-12451
THCIC Hospital Certifications Manual Version 1.0
Tx Hlth Care Info Collection - 649
Electronic File
E25-12452
THCIC Hospital Data Corrections Manual Version 1.0
Tx Hlth Care Info Collection - 649
Electronic File
E25-12453
Hospital Discharge Data Collection THCIC 837 Technical Specifications Ver 15
Tx Hlth Care Info Collection - 649
Electronic File
E25-12462
THCIC Hospital Numbered Letters Volume 6
Tx Hlth Care Info Collection - 724
Electronic File
E25-12455
THCIC Hospital HyperTerminal Setup Manual Version 1.0
Tx Hlth Care Info Collection - 649
Electronic File
E25-12463
THCIC Hospital Numbered Letters Volume 7
Tx Hlth Care Info Collection - 724
Electronic File
E25-12458
THCIC Hospital Numbered Letters Volume 2
Tx Hlth Care Info Collection - 724
Electronic File
E25-12459
THCIC Hospital Numbered Letters Volume 3
Tx Hlth Care Info Collection - 724
Electronic File
E25-12460
THCIC Hospital Numbered Letters Volume 4
Tx Hlth Care Info Collection - 724
Electronic File
E25-12449
THCIC 837 Claim-Technical Discussion (Creating Data in THCIC 8317-Discussion Notes)
Tx Hlth Care Info Collection - 649
Electronic File
Hygiene / Higiene E5-200
Cover Your Cough
Infectious Disease - 602
Electronic File
E23-12787
Double Handwash (poster)
Food Establishments - 713
Electronic File
E23-12785
Employees Must Wash Hands Before Returning to Work (handwash poster)
Food Establishments - 713
Electronic File
E5-100
MRSA Hygiene Awareness
Infectious Disease - 400
Electronic File
Immunization / Inmunizacion EC-33
Monthly Vaccine Report (Monthly Biological Report)
Immunization - 781
Electronic File
EC-11
School/Daycare Immunization Record
Immunization - 781
Electronic File
EC-110
Rotavirus Vaccine: What you should know (VIS)
Immunization - 781
Electronic File
EC-111
HPV (Human Papillomavirus) Vaccine-What You Need to Know (Cervarix) Vaccine Information State (VIS)
Immunization - 781
Electronic File
EC-112
Shingles Vaccine-What You Need to Know Vaccine Information Statement (VIS)
Immunization - 781
Electronic File
EC-108
Haemophilus Influenza Type B Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
EC-106
Hepatitis B Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
EC-114
HPV (Human Papillomavirus Vaccine) (Gardasil)-What You Need to Know (VIS)
Immunization - 41
Electronic File
EC-105
Temperature Recording Form
Immunization - 781
Electronic File
EC-109
Tetanus, Diphtheria and Pertusis (Tdap) Vaccine-What You need to know (VIS)
Immunization - 781
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 96 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
EC-5
First Responder/Family Member Withdrawal of Consent and Confirmation Form
Immunization - 887
Electronic File
EC-64
Play it Safe, Vaccinate (postcard)
Immunization - 781
Electronic File
EC-68-1
TVFC - Biological Order Form - Pediatric
Immunization - 781
Electronic File
EC-68-2
TVFC - Biological Order Form - Adult
Immunization - 781
Electronic File
EC-8
Withdrawal of Consent or Confirmation Form
Immunization - 887
Electronic File
EC-69
Texas Vaccine Loss Report Form
Immunization - 781
Electronic File
EC-7
ImmTrac - DSHS Immunization Registry Consent Form
Immunization - 781
Electronic File
EC-76
Vaccine Adverse Event Reporting System (VAERS)
Immunization - 781
Electronic File
E6-67
Story of Shots Booklet
Immunization - 781
Electronic File
E6-180
Warning Sign for Freezer/Refrigerator (Vaccine Storage)
Immunization - 781
Electronic File
EC-84
2009 H1N1 Inactivated Influenza Vaccine - What You Need to Know (VIS)
Immunization - 41
Electronic File
EC-83
H1N1 Live, Intranasal Influenza Vaccine-What You need to Know (VIS)
Immunization - 41
Electronic File
Imm-TVFC
Hurricane Relief - Vaccine Agreement Form
Immunization - 562
Electronic File
E6-216
Liability Protection for Children's Immunization Providers
Immunization - 781
Electronic File
E1-316
Information for Parents of Newborns (required in SB 316)
Perinatal/Maternal/Child 539
Electronic File
E54-11999
Hot Shot News (newsletter)
HSR - Immunization - 469
Electronic Newsletter/Magazine
E59-11016
Facts about Meningococcal Meningitis (Invasive)
Infectious Disease - 183
Electronic File
E59-11528
If you Have Hep C, Get Vaccinated Against Hep A & B
Infectious Disease - 533
Electronic File
E6-102
Texas Vaccines for Children Program-Provider Enrollment Form
Immunization - 781
Electronic File
E6-103
Immunization Requirements for Children & Students (Professional)
Immunization - 781
Electronic File
E6-104
Recommended Adult Immunization Schedule-United States
Immunization - 781
Electronic File
E6-105
Recommended Childhood & Adolescent Immunization ScheduleUnited States
Immunization - 781
Electronic File
E6-106
Vaccine-Preventable Disease Surveillance Guidelines
Infectious Disease - 58
Electronic File
EF11-10868
Rash Fever Illness Case Track Record
Infectious Disease - 727
Electronic File
E6-214
These Are the Times You'll Want to Remember (8-1/2" x 11" poster)
Immunization - 781
Electronic File Electronic File
EC-85
Pneumococcal Conjugate Vaccine-What You Need to Know (VIS)
Immunization - 781
E6-61
Contraindications & Precautions to Immunizations
Immunization - 781
Electronic File
E6-217
Your Kid's Ticket to a Healthier Life (brochure)
Immunization - 781
Electronic File
E6-217P
Your Kid's Ticket to a Healthier Life (8-1/2" x 11" poster)
Immunization - 781
Electronic File
E6-218
Protect Texas Children - ImmTrac Texas Immunization Registry (Brochure)
Immunization - 781
Electronic File
E6-250
MMWR General Recommendations on Immunization
Immunization - 781
Electronic File
E6-251
Standards for Child and Adolescent Immunization Practices
Immunization - 781
Electronic File
E6-252
Standards for Adult Immunization Practices
Immunization - 781
Electronic File
E6-26
Recommendation for Handling & Storage of Selected Biologicals Booklet
Immunization - 781
Electronic File
E6-26P
Vaccine Management-Recommendations for Handling & Storage of Selected Biologicals (8-1/2" x 11")
Immunization - 781
Electronic File
E6-305
Every Dose Counts-4th DTaP Poster (8-1/2" x 11")
Immunization - 781
Electronic File
E6-306
Every Dose Counts-4th DTaP Poster (8-1/2" x 11")
Immunization - 781
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 97 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E6-36
Fees for Vaccine Administration
Immunization - 781
E6-205
These Are the Times You'll Always Want to Remember
Immunization - 781
Electronic File
F11-11443
TVFC-Provider Withdrawal Form
Immunization - 293
Forms
EF11-12955
Immunization Registry (ImmTrac) First Responder/Family Member Request Form
Immunization - 887
Electronic File
EF11-13285
Screening Questionaire for Injectable 2009 H1N1 Influenza Vaccine
Immunization - 832
Electronic File
EF11-13286
Screening Questionaire for Intranasal 2009 H1N1 Influenza Vaccine
Immunization - 832
Electronic File
EF11-13431
Japanese Encephalitis Vaccine (Ixiaro)-What You need to know (VIS)
Immunization - 41
Electronic File
EF11-13432
Japanese Encephalitis Vaccine (JE-VAX)-What You need to know (VIS)
Immunization - 41
Electronic File
EF11-13500
ImmTrac Site Agreement and Confidentiality Statement Update/Renewal Form
Immunization - 887
Electronic File
EF11-13501
ImmTrac Provider Withdrawal Form
Immunization - 888
Electronic File
EF11-13502
ImmTrac No Provider Withdrawal Form
Immunization - 888
Electronic File
exclusion-
Exclusion from Immunizations for Reason of Conscience Affadavit Form (Conscientious Exemption)
Immunization - 503
Electronic File
EF11-10866
Acute Hepatitis B Case Track Record
Infectious Disease - 727
Electronic File
F11-11205
ImmTrac Site Registration Form for Providers
Immunization - 293
Forms
EF11-11406
Authorization to Release ImmTrac History Form
Immunization - 887
Electronic File
F11-11229
Quality Assurance On-site Evaluation Report Tool--Immunization Division
Immunization - 293
Forms
Imm-TempProv
Emergency Provisional Enrollment for Victims of Hurricane Katrina (immunization)
Immunization - 562
Electronic File
F11-12887
Uniform Stamp Replacement Form (Yellow Fever)
Immunization - 293
Forms
F11-11755
Exclusion from Immunizations for Reasons of Conscience Affadavit Form (Conscientious Exemption)
Immunization - 293
Forms
F11-11974
Yellow Fever Vaccination Renewal Form (Public Health Regions)
Immunization - 293
Forms
F11-11971
Yellow Fever Vaccination Renewal Form (Providers)
Immunization - 293
Forms
F11-11972
Yellow Fever Vaccination Application Form (Providers)
Immunization - 293
Forms
F11-11973
Yellow Fever Vaccination Application Form (Public Health Regions)
Immunization - 293
Forms
F11-11206
Memorandum of Understanding and Confidentiality Statement for Providers
Immunization - 293
Forms
E11-13503
ImmTrac First Responder Fact Sheet
Immunization - 889
Electronic File
F11-10949
Immunization Division Order Form
Immunization - 293
Forms
EF11-10867
Tetanus Case Track Record
Infectious Disease - 727
Electronic File
EC-87
Live Intranasal Influenza Vaccine-What You Need to Know - VIS
Immunization - 781
Electronic File
EC-89
Oral Polio Vaccine-What You Need to Know (VIS)
Immunization - 41
Electronic File
EC-90
Polio-What You Need to Know (IPV) (VIS)
Immunization - 781
Electronic File
EC-91
Diphtheria, Tetanus, and Pertussis-What You Need to Know (VIS)
Immunization - 781
Electronic File
EC-92
Measles, Mumps, and Rubella Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
EC-93
Inactivated Influenza Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
EC-94
Tetanus and Diphtheria-What You Need To Know (VIS)
Immunization - 781
Electronic File
EC-95
Hepatitis A Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
EC-96
Meningococcal Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
EC-97
Chickenpox Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
Stock #4-25-lang Revised 10/25/2010
Electronic File
Page 98 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF11-12887
Uniform Stamp Replacement Form (Yellow Fever)
Immunization - 741
Electronic File
ECORE-5
Flow Sheet Immunizations (no print copy available)
Public Health Nursing - 263 Electronic File
EF11-12221
Japanese Encephalitis Vaccine-What You need to Know - Vaccine Information Statement (VIS)
Immunization - 41
Electronic File
EF11-10869
Mumps Case Track Record
Infectious Disease - 727
Electronic File
EF11-10870
Pertussis Case Track Record
Infectious Disease - 727
Electronic File
EF11-10871
Haemophilus Influenzae Case Track Record
Infectious Disease - 727
Electronic File
EF11-10931
Infant Summary Report for Perinatal Hepatitis B Prevention
Infectious Disease - 668
Electronic File
EF11-10932
Mother Summary Report for Perinatal Hepatitis B Prevention
Infectious Disease - 668
Electronic File
EF11-10934
Contact Summary Report for Perinatal Hepatitis B Prevention
Infectious Disease - 668
Electronic File
EF11-11014
Physician's Prenatal Report HBsAg-Positive Mother
Infectious Disease - 668
Electronic File
EF11-11015
Hospital Delivery Report of HBsAg-Positive Mother
Infectious Disease - 668
Electronic File
EF11-11046
Varicella (Chickenpox) Reporting Form
Infectious Disease - 727
Electronic File
EC-86
Pneumococcal Polysaccaride Vaccine-What You Need to Know (VIS)
Immunization - 781
Electronic File
EC-99
Rabies-What You Need to Know (VIS)
Immunization - 781
Electronic File
E11-10950
The Upshot
Immunization - 167
Electronic File
C-8
Immunization Registry Withdrawal Form
Immunization - 293
Forms
C-85
Pneumococcal Conjugate Vaccine-What You Need to Know (VIS)
Immunization - 710
Forms Forms
C-86
Pneumococcal Polysaccaride Vaccine-What You Need to Know (VIS)
Immunization - 710
C-90
Polio-What You Need to Know (IPV)
Immunization - 710
Forms
C-91
Diphtheria, Tetanus, and Pertussis-What You Need to Know
Immunization - 710
Forms
C-92
Measles, Mumps, and Rubella Vaccine-What You Need to Know (Limit 200)
Immunization - 710
Forms
C-94
Tetanus and Diphtheria-What You Need To Know
Immunization - 710
Forms
C-95
Hepatitis A Vaccine-What You Need to Know
Immunization - 710
Forms
C-96
Meningococcal Vaccine-What You Need to Know (Limit 200)
Immunization - 710
Forms
E11-12047
The Importance of Childhood Hepatitis B Immunizations (White Paper)
Immunization - 480
Electronic File
E11-10373
Texas Vaccines for Children Fraud and Abuse Pamphlet
Immunization - 781
Electronic File
C-64
Play it Safe, Vaccinate (postcard) (Limit 500)
Immunization - 710
Postcards
E11-10951
Texas Child Care Facility Report of Immunization Status (annual)
Immunization - 786
Electronic File
E11-11161
Anthrax Vaccine-What You Need to Know - Vaccine Information Statement (VIS)
Immunization - 41
Electronic File
E11-11221
Texas Vaccines for Children Questions and Answers
Immunization - 787
Electronic File
E11-11443
Texas VFC-Provider Withdrawal Form
Immunization - 781
Electronic File
E11-11444
Client Brochure (Perinatal Hepatitis B)
TB Elimination - 855
Electronic File
E11-11530
Is it just a cough? Or is it pertussis/whooping cough
Immunization - 781
Electronic File
E11-11700
Anyone Can Get Pertussis - Adult
Immunization - 781
Electronic File
E11-11966
Play it Safe. Vaccinate.
Immunization - 781
Electronic File
E11-11989
For the Record
Immunization - 779
Electronic Newsletter/Magazine
C-97
Chickenpox Vaccine-What You Need to Know (Limit 200)
Immunization - 710
Forms
6-61
Contraindications & Precautions to Immunizations
Immunization - 710
Posters
11-11424
Pertussis (Whooping Cough) Fact Sheet/Pertusis (La tos fernia) hoja de informes
Immunization - 293
Fact Sheets
Stock #4-25-lang Revised 10/25/2010
Page 99 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
11-12815
Vaccines Full Protection (magnet)
Immunization - 293
Magnets
45-10523
If You Have Diabetes, A Flu Shot Could Save Your Life (poster)
Texas Diabetes Council 305
Posters
50-11807
Vaccine for Children Immunization Newsletter (Region 1)
HSR 1- Immunization - 330 Newsletters
54-11999
Hot Shot News (newsletter)
HSR - Immunization - 468
Newsletters
59-13390P
Perinatal Hepatitis B Provider Poster
Immunization - 293
Posters
59-13391P
Perinatal Hepatitis B Parent Poster
Immunization - 293
Posters
6-214
These Are the Times You'll Want to Remember (18" x 23"poster) (Limit 50)
Immunization - 710
Posters
6-217P
Your Kid's Ticket to a Healthier Life (16" x 20"poster) (Limit 50)
Immunization - 710
Posters
C-76
Vaccine Adverse Event Reporting System (VAERS)
Immunization - 710
Forms
6-36
Fees for Vaccine Administration (Limit 50)
Immunization - 710
Posters
C-7
ImmTrac - DSHS Immunization Registry Consent Form
Immunization - 710
Forms
C-105
Temperature Recording Form
Immunization - 710
Forms
C-106
Hepatitis B Vaccine-What You Need to Know (Limit 200)
Immunization - 710
Forms
C-108
Haemophilus Influenza Type B Vaccine-What You Need to Know
Immunization - 710
Forms
C-11
School/Daycare Immunization Record
Immunization - 710
Forms
C-110
Rotavirus Vaccine-Vaccine Information Statement (VIS) (Limit 200)
Immunization - 710
Forms
C-111
HPV (Human Papillomavirus) Vaccine-What You Need to Know (Cervarix) (VIS) (Limit 200)
Immunization - 710
Forms
C-112
Shingles Vaccine-What You Need to Know Vaccine Information Statement (VIS) (Limit 50)
Immunization - 710
Forms
C-114
HPV (Human Papillomavirus Vaccine) (Gardasil)-What You Need to Know (VIS)
Immunization - 293
Forms
C-5
First Responder/Family Member Withdrawal of Consent and Confirmation Form
Immunization - 293
Forms
C-68-Flu
TVFC-Influenza Vaccine Order Form
Immunization - 293
Forms
6-26P
Vaccine Management-Recommendations for Handling & Storage of Selected Biologicals (17" x 33"Poster)
Immunization - 710
Posters
E11-13035
Setting Up a Reminder/Recall System
Immunization - 781
Electronic File
E11-13499
ImmTrac Reporting Seasonal Influenza Vaccine FAQ
Immunization - 888
Electronic File
F11-11231
Texas Vaccines For Children Risk Assessment Tool
Immunization - 293
Forms
E11-13160
Immunization Requirements for School Admittance Frequently Asked Questions (FAQs)
Immunization - 780
Electronic File
E11-13255
Provisional Enrollment Flowchart
Immunization - 780
Electronic File
E11-13287
How to Use the 2009 H1N1 Vaccine Information Statement Addendum (Frequently Asked Questions)
Immunization - 832
Electronic File
E11-13288
Instructions for Accessing Texas Vaccine Education Online
Immunization - 779
Electronic File
E11-13159
Exemption from Immunization for Reasons of Conscience FAQs
Immunization - 780
Electronic File
E11-13289
Electronic Data Reporting vis EMR Systems
Immunization - 779
Electronic File
E11-13036
Talking to Parents about Vaccines
Immunization - 781
Electronic File
E11-13292
ImmTrac Applications Report Descriptions
Immunization - 779
Electronic File
E11-13291
Consent Guidelines for Users not Affirming Consent
Immunization - 779
Electronic File
C-6
ImmTrac Provider Registration Form
Immunization - 293
Forms
E11-13034
Improving Vaccine Coverage Levels
Immunization - 781
Electronic File
E11-13293
ImmTrac Data Sources
Immunization - 779
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 100 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E11-12375
Overview of Vaccines for Children Program
Immunization - 614
Electronic File
E11-13419
ImmTrac-First Responders-In an Emergency (color- half page)
Immunization - 865
Electronic File
E11-12050
Typhoid Vaccine-What You Need to Know - Vaccine Information Statement (VIS)
Immunization - 41
Electronic File
E11-13418
ImmTrac-First Responders-In an Emergency (color- full page)
Immunization - 865
Electronic File
E11-12051
Yellow Fever Vaccine-What You Need to Know - Vaccine Information Statement (VIS)
Immunization - 41
Electronic File
E11-13290
ImmTrac-FAQ Sheet for Healthcare Providers
Immunization - 779
Electronic File
E11-13417
ImmTrac-First Responders-In an Emergency (b/w - half page)
Immunization - 865
Electronic File
E11-12874
New Legislation (SB 11, 80th Legislative Session)
Immunization - 739
Electronic File
E11-12555
TVFC-Quality Assurance Manual
Immunization - 614
Electronic File
E11-13416
ImmTrac-First Responders-In an Emergency (b/w - full page)
Immunization - 865
Electronic File
E11-13415
ImmTrac TX Imm Registry Electronic Transfer Standards for Consent Affirmation
Immunization - 739
Electronic File
E11-13314
2009 E-card (Electronic postcard-Immunizations)
Immunization - 844
Electronic File
E11-12811
Little Kids Get the Flu Too
Immunization - 781
Electronic File
E11-12873
Current Texas Law: Immunization Reporting and Consent Requirements
Immunization - 739
Electronic File
E11-12155
Giving all the Doses Chart
Immunization - 781
Electronic File
Infants - Care & Hygiene / Bebes--su cuidado e higiene 06-10325
Diarrhea in Infancy and Early Childhood, No. 15 (Restricted to WIC Local Agencies)
Fact Sheets
06-10324
Constipation in Infancy and Childhood, No. 14 (Restricted to WIC Local Agencies)
Fact Sheets
05-10589
Neonatal Screening: Blood Specimen Collection & Handling Procedure (Limit 5)
Newborn Screening - 67
Posters
1-159
Texas Newborn Screening Program Bookmark (Limit 5)
Warehouse
Bookmarks
7-21
Preventing Dog Bites to Infants
Warehouse
Posters
E05-10589
Neonatal Screening: Blood Specimen Collection & Handling Procedure
Newborn Screening - 556
Electronic File
E05-02233
Hypothyroidism and Your Infant
Newborn Screening - 317
Electronic File
F05-11770
Application for Formula Assistance (Limit 5)
Newborn Screening - 136
Forms
E05-06836
Newborn Screening Program Practitioner's Guide
Newborn Screening - 68
Electronic File
E13-53
Just for Dad
Nutrition Services - 809
Electronic File
EF59-11344
Botulism--Infant Reporting Form
Infectious Disease - 185
Electronic File
ENBH-PB1
Texas Early Hearing Detection and Intervention Program, Information Professionals Need to Know
Texas Health Steps - 24
Electronic File
TCADA-43
Texas Survey of Postpartum Women and Drug-Exposed Infants
Mental Hlth/Sub Abuse 488
Electronic File
E05-10631
Weight Conversion Chart: Pounds and Ounces to Grams (Limit 5)
Newborn Screening - 68
Electronic File
EF05-11770
Application for Formula Assistance
Newborn Screening - 281
Electronic File
E1-63
Newborn Screening: For Your Baby's Health
Newborn Screening - 68
Electronic File
EF11-10931
Infant Summary Report for Perinatal Hepatitis B Prevention
Infectious Disease - 668
Electronic File
E1-319
What Parents Want to Know About Newborn Screening: From Their Baby's Health Professional
Newborn Screening - 68
Electronic File
E1-318
These Tests Could Save Your Baby's Life: Newborn Screening Tests
Newborn Screening - 68
Electronic File
E06-10472
Newborn Screening Card
Newborn Screening - 319
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 101 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E06-10324
Constipation in Infancy and Childhood, No. 14
Nutrition Services - 199
Electronic File
E13-13262
Shortage of Erythromycin Ophtalimc Ointment for Neonatal Prophylaxix of Chlamydia and Gonorrhea
HIV/STD - 783
Electronic File
E13-06-11236
Weaning from the Breast
Nutrition Services - 570
Electronic File
E13-06-10391
Weaning From the Bottle, How to Handle Both the Typical and Slowto-Wean Child, No. 16
Nutrition Services - 199
Electronic File
NBS-magnet
Step by Step: Your New Baby Must Have a Second Screening Test at 1-2 Weeks of Age (Limit 5)
Newborn Screening - 136
Magnets
E1-316
Information for Parents of Newborns (required in SB 316)
Perinatal/Maternal/Child 539
Electronic File
E06-10325
Diarrhea in Infancy and Early Childhood, No. 15
Nutrition Services - 199
Electronic File
E76-11559
Position Statement Relating to Newborn Hearing Screening
State Bd of Examiners Speech & Audiology - 435
Electronic File
Infants - Nutrition / Bebes--su nutricion E13-06-10391
Weaning From the Bottle, How to Handle Both the Typical and Slowto-Wean Child, No. 16
Nutrition Services - 199
Electronic File
E06-10111
Infant Feeding: Low-Birth Weight and Pre-Term Infants, No. 7
Nutrition Services - 199
Electronic File
13-25
Girl Crib Card
Nutrition Services - 885
Small card
E1-63
Newborn Screening: For Your Baby's Health
Newborn Screening - 68
Electronic File
F05-11770
Application for Formula Assistance (Limit 5)
Newborn Screening - 136
Forms
EIF-000-09
Infant Feeding Bingo
Nutrition Services - 416
WIC Lesson/TrainingElectronic
E13-46
Mother's Milk For Premature Babies
Nutrition Services - 570
Electronic File
E13-06-10760
Bottled Water and Infant Formula, No. 20
Nutrition Services - 199
Electronic File
E13-159
Texas Position Statement on Infant Feeding
Nutrition Services - 506
Electronic File
EF05-11770
Application for Formula Assistance
Newborn Screening - 281
Electronic File
Injury Surveillance / Vigilancia de herida E09-13260
Top 5 Causes of Injury Hospitalization by TSA
Prevention & Preparedness - 829
Electronic File
E09-12401
Injury Surveillance Brief Series: Drownings in Texas
Epidemiology/Injury Surveillance - 516
Electronic File
E09-13142
2006 Texas Cause of Injury Profiles by Trauma Service Areas as Reported by Hospitals
Epidemiology/Injury Surveillance - 516
Electronic File
E09-13143
2006 Texas Cause of Injury Profiles by Trauma Service Areas as Reported by EMS Providers
Epidemiology/Injury Surveillance - 516
Electronic File
E09-13259
Top 5 Causes of Injury Death, Disability, and Hospital Charges in Texas v2
Prevention & Preparedness - 829
Electronic File
E09-13446
Non-fatal Injury Hospitalizations by TSA-2004 (Texas)
Prevention & Preparedness - 829
Electronic File
E09-13447
Non-fatal Injury Hospitalizations by TSA-2005 (Texas)
Prevention & Preparedness - 829
Electronic File
E09-13448
Non-fatal Injury Hospitalizations by TSA-2006 (Texas)
Prevention & Preparedness - 829
Electronic File
E09-MT03LV
Mortality in Trauma Service Area by Cause: RACs L-V 2003
Epidemiology/Injury Surveillance - 516
Electronic File
E09-13449
Non-fatal Injury Hospitalizations by TSA-2007 (Texas)
Prevention & Preparedness - 829
Electronic File
E09-MT04LV
Mortality in Trauma Service Area by Cause: RACs L-V 2004
Epidemiology/Injury Surveillance - 516
Electronic File
E09-MT04AK
Mortality in Trauma Service Area by Cause: RACs A-K 2004
Epidemiology/Injury Surveillance - 516
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 102 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E09-MT03AK
Mortality in Trauma Service Area by Cause: RACs A-K 2003
Epidemiology/Injury Surveillance - 516
Electronic File
E09-MB04LV
Top Five Causes of Injury-related Hospitalizations: RACs L-V 2004
Epidemiology/Injury Surveillance - 516
Electronic File
E09-MB03AK
Top Five Causes of Injury-related Hospitalizations: RACs A-K 2003
Epidemiology/Injury Surveillance - 516
Electronic File
E09-13450
Non-fatal Injury Hospitalizations by TSA-2008 (Texas)
Prevention & Preparedness - 829
Electronic File
E09-MB03LV
Top Five Causes of Injury-related Hospitalizations: RACs L-V 2003
Epidemiology/Injury Surveillance - 516
Electronic File
E09-MB04AK
Top Five Causes of Injury-related Hospitalizations: RACs A-K 2004
Epidemiology/Injury Surveillance - 516
Electronic File
Insect Control / Control de insectos G-14
Mosquito Surveillance Adult/Larval Submission Form
Labs - 30
Forms
E7-7
Encephalitis
Zoonosis - 376
Electronic File
E7-36
Facts About Plague
Zoonosis - 376
Electronic File
E7-35
Lyme Disease
Zoonosis - 376
Electronic File
E7-32
Murine Typhus (Fleaborne typhus)
Zoonosis - 376
Electronic File
E7-24
Rocky Mountain Spotted Fever
Zoonosis - 376
Electronic File
E19-11724
Defend Yourself Against West Nile Virus
Infectious Disease - 381
Electronic File
E19-13246
What you need to know about Mosquitoes
Communications - 827
Electronic File
Kidney Health / Salud del rinon E41-10979
Kidney Health Care Recipient Handbook
Kidney Health Care - 180
Electronic File
E41-12933
Kidney Health Care Program Access Surgery Quick Sheet
Kidney Health Care - 688
Electronic File
E41-10766
Kidney Health Care Annual Report
Kidney Health Care - 775
Electronic File
E41-10978
Kidney Health Care Rules
Kidney Health Care - 776
Electronic File
E41-12782
ASKIT Web Installation Guide
Kidney Health Care - 711
Electronic File
EF41-10981
KHC Non-Contracted Dialysis Provider Information Form
Kidney Health Care - 180
Electronic File
EF41-10982
KHC Contracted Dialysis Provider Information Form
Kidney Health Care - 180
Electronic File
EF41-12836
KHC Prescription Drug Plan Provider Enrollment Form
Kidney Health Care - 180
Electronic File
EKHC-010
You Just Applied to KHC! (Kidney Health Care)
Kidney Health Care - 180
Electronic File
EKHC-3
Kidney Health Care-Transportation Claim Form
Kidney Health Care - 180
Electronic File
EKHP-1
Kidney Health Care-Application for Benefits
Kidney Health Care - 180
Electronic File
EKHP-1B
Kidney Health Care-Instructions for Application for Benefits
Kidney Health Care - 180
Electronic File
EKHP-1C
Kidney Health Care-Residency Documents
Kidney Health Care - 180
Electronic File
KHC-3
Kidney Health Care-Transporation Claim Form
Kidney Health Care - 179
Forms
KHP-1
Kidney Health Care-Application for Benefits & Instruction
Kidney Health Care - 179
Forms
Laboratories & Laboratory Safety / Laboratorios y Seguridad de laboratorios E05-10588
Simple Spot Check
Newborn Screening - 556
Electronic File
05-10588
Simple Spot Check (Limit 5)
Newborn Screening - 67
Posters
05-10589
Neonatal Screening: Blood Specimen Collection & Handling Procedure (Limit 5)
Newborn Screening - 67
Posters
05-10897
Newborn Screening News
Newborn Screening - 67
Newsletters
14-13277
Submitter Identification (ID) Number Request Form
Labs - 818
Forms
Stock #4-25-lang Revised 10/25/2010
Page 103 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
TB-supplies
Order Form-TB Supplies
Labs - 578
Electronic File
EG-9
Rabies Submission Form (Laboratory Test for Rabies)
Labs - 578
Electronic File
E14-13277
Submitter Identification (ID) Number Request Form
Labs - 819
Electronic File
F14-03252
Newborn Screening Supplies Order Form
Labs - 30
Forms
F14-13230
Use and Storage of Newborn Screening Bloodspot Cards (Directive to Destroy)
Labs - 818
Forms
G-14
Mosquito Surveillance Adult/Larval Submission Form
Labs - 30
Forms
G-19
Water Bacteriology Specimen Submission Form
Labs - 30
Forms
G-194
Newborn Screening Specimen Collection (NBS Specimen Collection)
Labs - 30
Forms
G-1A
Specimen Submission Form (Bacteriology Testing)
Labs - 388
Forms
G-1B
Specimen Submission Form (Clinical ChemistryTesting)
Labs - 388
Forms
E05-10589
Neonatal Screening: Blood Specimen Collection & Handling Procedure
Newborn Screening - 556
Electronic File
G-22
Consumer Health Form
Warehouse
Forms
EG-6B
Order Form-Title V/SDI-Containers and Forms, Labels and Kits (2 order forms per page)
Labs - 578
Electronic File
G-23
Food Sample Form
Labs - 30
Forms
G-2A
Serology and Virology Specimen Submission Form
Labs - 388
Forms
G-2B
Bacteriology and Parasitology Specimen Submission Form
Labs - 388
Forms
G-399
THSteps/Child Health Laboratory Supplies Form
Labs - 30
Forms
T-1
Newborn Screening Thyroid specimens
Labs - 388
Forms
G-6A
Order Form-Containers and Forms, Labels & Kits
Labs - 30
Forms
PKU-orderform
Order Form-PKU Monitoring Lab Supplies
Labs - 578
Electronic File
LabManual
Manual of Reference Services (Laboratories)
Labs - 579
Electronic File
G-9
Rabies Submission Form (Laboratory Test for Rabies)
Labs - 30
Forms
G-1C
Maternal Serum Prenatal Triple Screen Specimen Submission Form
Labs - 388
Forms
EF14-13230
Use and Storage of Newborn Screening Bloodspot Cards (Directive to Destroy)
Labs - 819
Electronic File
E05-10897
Newborn Screening News
Newborn Screening - 153
Electronic Newsletter/Magazine
E1-194
Specimen Collection Guide
Newborn Screening - 68
Electronic File
E14-12843
Chemical Threat Response in Texas
Labs - 579
Electronic File
E14-13156
Laboratory Services Section Newsletter: The Laboratorian
Labs - 821
Electronic Newsletter/Magazine
E14-13224
Testing for H1N1 (Swine) Influenza Viruses by the Public Health Laboratories
Labs - 822
Electronic File
E14-13308
Severe Combined Immunodeficiency (SCID)
Labs - 819
Electronic File
GenProbe-form
Order Form-GenProbe Collectors
Labs - 578
Electronic File
E59-11364
Notifiable Conditions in Texas
Infectious Disease - 112
Electronic File
E59-11366
Laboratory Results That Must Be Reported To the Local Health Authority
Infectious Disease - 430
Electronic File
E59-11370
Essential Epidemiology and Laboratory Components of a State Foodborne Disease Prev & Control Program
Infectious Disease - 431
Electronic File
EF14-03252
Newborn Screening Supplies Order Form
Labs - 578
Electronic File
EG-6A
Order Form-Containers and Forms, Labels and Kits (2 order forms per page)
Labs - 578
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 104 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EG-399
THSteps/Child Health Laboratory Supplies Form (2 order forms per page)
Labs - 578
Electronic File
EG-19
Water Bacteriology Specimen Submission Form
Labs - 580
Electronic File
Law Enforcement / Autoridades policiales EF12-11463
Correctional Tuberculosis Screening Plan
Infectious Disease Control Unit - TB - 320
Electronic File
E59-12432
Taking Care of Wounds that are Draining or Have Not Healed
Infectious Disease - 400
Electronic File
txtob01-2
Operation Storefront: Observations of Texas Retailer Tobacco Advertising/Tobacco Laws Compliance
Substance Abuse Services - Electronic File Tobacco - 236
txtob01-3
Law Enforcement Officer Attitudes Toward Texas Tobacco Laws & Tobacco Enforcement Activities
Substance Abuse Services - Electronic File Tobacco - 236
Lead Poisoning / Intoxicacion por plomo F17-12576
Lead Notification Form
Envir Hlth Group - 689
Forms
EPB-103
Environmental Investigation Questionnaire (Childhood Lead Poisoning Prevention Prog)
Childhood Lead Poisoning - 385
Electronic File
EPB-104
Physician Checklist for Parent Education Topics
Childhood Lead Poisoning - 385
Electronic File
EPB-102
Provider Questionnaire (Childhood Lead Poisoning Prevention Prog)
Childhood Lead Poisoning - 385
Electronic File
EPB-101
Request for Environmental Investigation (Childhood Lead Poisoning Prevention Prog)
Childhood Lead Poisoning - 385
Electronic File
EF17-12576
Lead Abatement Notification Form
Envir Hlth Group - 690
Electronic File
PB-103
Environmental Investigation Questionnaire (Childhood Lead Poisoning Prevention Prog)
Childhood Lead Poisoning - 379
Forms
F09-11624
Adult Blood Lead Reporting Form
Blood Lead Epi - 862
Forms
EPB-109
Physician Reference on Follow-up Testing and Case Management
Childhood Lead Poisoning - 385
Electronic File
1-313
Childhood Blood Lead Testing: Getting a Good Specimen
Warehouse
Posters
4644
Firing Ranges Employer's Guide
Epidemiology - 663
Electronic File
E09-04628
Firing Ranges Shooter's Guide
Epidemiology - 663
Electronic File
E09-11441
Texas Childhood Lead Poisoning Prevention Program Newsletter
Childhood Lead Poisoning - 385
Electronic Newsletter/Magazine
E09-13425
Scouts of America: Keeping Yourself Lead Safe
Blood Lead Epi - 863
Electronic File
E09-13426
Lead Safety During Home Renovations
Blood Lead Epi - 863
Electronic File
EF09-11709
Childhood Blood Lead Level Report Form
Childhood Lead Poisoning - 385
Electronic File
E1-26
What Parents Need to Know About Lead Poisoning
Childhood Lead Poisoning - 386
Electronic File
E1-312
A Guide for Educators: Childhood Lead Poisoning and How You Can Help Families Prevent It
Childhood Lead Poisoning - 385
Electronic File
EF09-11624
Adult Blood Lead Reporting Form
Blood Lead Epi - 863
Electronic File
E1-314
Here to Help You
Childhood Lead Poisoning - 385
Electronic File
E06-10213
Lead Poisoning, No. 10
Nutrition Services - 199
Electronic File
E1-313
Childhood Blood Lead Testing: Getting a Good Specimen
Childhood Lead Poisoning - 385
Electronic File
PB-104
Physician Checklist for Parent Education Topics
Warehouse
Forms
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
Licensing & Regulation / Autorizacion y Reglamentacion EF75-10757
Licensed Professional Counselor - Application Packet
Stock #4-25-lang Revised 10/25/2010
Page 105 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF75-11360
Professional Licensing and Certification Division Complaint Form
Professional Licensing and Certification - 246
Electronic File
EF75-11220
Professional Licensing and Certification Division - Complaint Packet
Professional Licensing and Certification - 246
Electronic File
EF75-10967
St Bd of Exam of Prof CounselorsSupervisory Agreement Form
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF75-10966
St Bd of Exam of Prof Counselors-Supervisor Application Form
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF75-10963
St Bd of Exam of Prof Counselors-Supervised Experience Documentation Form
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF75-10781
St Bd of Examiners of Prof Counselors-Pre-Approved Cont Educ Prov Appl
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF74-13387
Perfusionist Application Packet
Tx State Bd of Examiners of Perfusionists - 853
Electronic File
EF73-12966
Requirements for Licensure as a Licensed Marriage and Family Therapist/Associate in Texas
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF76-11177
Continuing Education-College University Course Work Form
State Bd of Examiners for Speech & Audiology -240
Electronic File
EF75-10962
St Bd of Exam of Prof Counselors-Practicum Documentation
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF75-11361
Professional Licensing and Certification Division Complaint General Release Form
Professional Licensing and Certification - 246
Electronic File
EF76-10909
Inactive Status Form (Speech)
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF76-10910
Late Renewal Form (Speech)
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF76-11145
Request to Change Name Form (Speech)
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF76-11163
Felony/Misdemeanor Evaluation Form
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF73-12965
Form VII-Examination Security Information Acknowledgement Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF76-11176
Rating Scale of Assistant's Performance Form
State Bd of Exam of Speech & Audiology - 213
Electronic File
F64-10701
Massage Therapy Registration Application
Massage Therapy Program - 122
Forms
EF76-13408
Alternate Supervision of an Assistant Request Plan
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF72-10745
Dietitian Application for Licensure
Tx State Bd of Examiners of Dietitians - 508
Electronic File
EF76-11175
Clinical Deficiency Plan Completion of Training for Assistants Form
State Bd of Exam of Speech & Audiology - 213
Electronic File
TAC139.6(a)(1)
Information on Toll-Free Telephone Number (Abortion Facilities)
Abortion Facility Licensing - 634
Electronic File
EF73-12959
Form I-Course Equivalency Request (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-12433
MFT CE Provider Approval Application/Renewal Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-10753
Tx St Bd of Examiners of Marriage and Family Therapists Supervisory Agreement Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 106 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF73-10752
Tx St Bd of Examiners of Marriage and Family Therapists Supervisor Application
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-10751
Tx St Bd of Examiners of Marriage & Family Therapists -Supervised Experience Doc Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
F82-11154
Application Packet for Registration as a Code Enforcement Officer or a Code Enf Officer-In-Training
Code Enforcement Officers - 186
Forms
EF73-10748
Texas State Board of Examiners of Marriage & Family Therapists Application Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF82-11153
Code Enforcement Officer Examination Request Form
Code Enforcement Officers - 219
Electronic File
EF72-12124
Dietitian Renewal Form
Tx State Bd of Examiners of Dietitians - 508
Electronic File
EF73-12960
Form II-Verification of Licensure in Other Jurisdiction (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
TAC139.52(a)(1)
Informed Consent Certification Form (Abortion Facilities)
Abortion Facility Licensing - 634
Electronic File
F82-11486
Replacement Registration Affidavit-Code Enforcement
Code Enforcement Officers - 186
Forms
EF73-12961
Form IV-Probation/Monitoring Supervision Plan (for licensees under board ordered supervision)
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-12962
Form B-Texas State Board of Marriage and Family Therapists Renewal Application Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-12963
Form B-Continuing Education Provider Approval Application/Renewal (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 460
Forms
EF73-12964
Form VI-Supervised Clinical Practicum Supervision and Experience Verification Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
TAC139.41(a)(8)
Affidavit of Age Form (Abortion Facilities)
Abortion Facility Licensing - 634
Electronic File
MSA-13
Operators Rendering Application
Drugs & Food Safety Licensing - 89
Electronic File
MSA-12
Construction Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
G-20
Texas DSHS Dairy Water Form
Milk Group - 746
Forms
F82-11487
Replacement Registration Affidavit-Registered Sanitarian
Registered Sanitarian - 36
Forms
EF69-13310
Application Form License Holder from Another State
St. Comm. Examrs. In Fit & Disp. Hear Instr - 279
Electronic File
F67-10722
Opticians Registry - Application for Optician Registration
Optician's Registry Program - 133
Forms
F71-10741
Texas Board of Orthotics and Prosthetics - Licensure Application Packet
Tx Bd of Orthotics & Prosthetics - 130
Forms
F71-10740
Texas Board of Orthotics and Prosthetics - Facility Accreditation Application Packet
Tx Bd of Orthotics & Prosthetics - 130
Forms
F70-10737
Texas Board of Licensure for Professional Medical Physicists License Appl Packet
Tx Bd Licensure for Prof. Medical Physicists - 134
Forms
F69-13310
Application Form License Holder from Another State
St. Comm. Examrs. In Fit & Disp. Hear Instr - 126
Forms
F69-11967
Application for Continuing Education Program Approval - Fitting & Disp of Hearing Instruments
St. Comm. Examrs. In Fit & Disp. Hear Instr - 126
Forms
Stock #4-25-lang Revised 10/25/2010
Page 107 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F69-10733
State Comm of Exam in Fitting & Disp of Hearing InstrumentsApplication Form
St. Comm. Examrs. In Fit & Disp. Hear Instr - 126
Forms
F68-10730
Respiratory Care Practitioners Certif Program - Late Renewal Deficiency Notification
Respiratory Care Pract. Certif. Program - 843
Forms
F68-10729
Respiratory Care Practitioners Certification Program - Exam Score Release Form
Respiratory Care Pract. Certif. Program - 843
Forms
F64-13397
Massage Therapy Educational Program Application for Basic 500Hour Program
Massage Therapy Program - 122
Forms
F67-12090
Statement of Continuing Education Form for Opticians
Optician's Registry Program - 133
Forms
F72-12124
Dietitian Renewal Form
Tx State Bd of Examiners of Dietitians - 127
Forms
F66-13412
Supervising Midwife/Apprentice Complaint Disclosure Form
Midwifery Program - 124
Forms
F66-10719
Newborn Screening Agreement for Newborn Babies of Midwife Clients
Midwifery Program - 124
Forms
F66-10718
Midwife Training Certification Form - Newborn Screening Specimen Collection
Midwifery Program - 124
Forms
F66-10717
Midwife Informed Choice and Disclosure Statement
Midwifery Program - 124
Forms
F66-10716
Midwife Documentation Application
Midwifery Program - 124
Forms
F66-10715
Midwife - Newborn Screening Test Objection Form
Midwifery Program - 124
Forms
F65-10711
Medical Radiologic Technologist Certification - Appl for Hardship Exemption
Medical Radiologic Technologist Certif Prog 123
Forms
EF77-10801
ACP/AP Supervision Forms Packet (Texas State Board of Social Worker Examiners)
Tx State Bd of Social Worker Examiners - 358
Electronic File
F68-10726
Respiratory Care Practitioners Application Packet
Respiratory Care Pract. Certif. Program - 843
Forms
F73-12963
Form B-Continuing Education Provider Approval Application/Renewal (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F75-10966
St Bd of Exam of Prof Counselors-Supervisor Application Form
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-10963
St Bd of Exam of Prof Counselors-Supervised Experience Documentation Form
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-10962
St Bd of Exam of Prof Counselors-Practicum Documentation
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-10781
St Bd of Examiners of Prof Counselors-Pre-Approved Cont Educ Prov Appl
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-10759
St Bd Exam of Professional Counselors - Counselor Cont Education Declaration
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-10757
Licensed Professional Counselor - Application Packet
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F74-13387
Perfusionist Application Packet
Tx State Bd of Examiners of Perfusionists - 135
Forms
F74-10755
Licensed Perfusionist or Provisional Licensed Perfusionist
Tx State Bd of Examiners of Perfusionists - 135
Forms
F71-11503
Orthotics & Prosthetics Board Continuing Education (CE) Report Form
Tx Bd of Orthotics & Prosthetics - 130
Forms
F73-12964
Form VI-Supervised Clinical Practicum Supervision and Experience Verification Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F72-10745
Dietitian Application for Licensure
Tx State Bd of Examiners of Dietitians - 127
Forms
Stock #4-25-lang Revised 10/25/2010
Page 108 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F73-12962
Form B-Texas State Board of Marriage and Family Therapists Renewal Application Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-12961
Form IV-Probation/Monitoring Supervision Plan (for licensees under board ordered supervision)
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-12960
Form II-Verification of Licensure in Other Jurisdiction (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-12959
Form I-Course Equivalency Request (Marriage and Family Therapists)
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-10753
Tx St Bd of Examiners of Marriage and Family Therapists Supervisory Agreement Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-10752
Tx St Bd of Examiners of Marriage and Family Therapists Supervisor Application
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-10751
Tx St Bd of Examiners of Marriage & Family Therapists -Supervised Experience Doc Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-10748
Texas State Board of Examiners of Marriage & Family Therapists Application Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F64-13389
Massage Therapy Instructor License Renewal Form
Massage Therapy Program - 122
Forms
F73-12965
Form VII-Examination Security Information Acknowledgement Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F76-11145
Request to Change Name Form (Speech)
State Bd of Examiners Speech & Audiology - 129
Forms
F60-10681
Athletic Trainer License Application Packet
Advisory Board of Athletic Trainers - 121
Forms
F47-10177
Condensed and Dry Milk and Whey
Milk Group - 31
Forms
EF82-11487
Replacement Registration Affidavit-Registered Sanitarian
Registered Sanitarian - 242
Electronic File
EF82-11486
Replacement Registration Affidavit-Code Enforcement
Code Enforcement Officers - 219
Electronic File
EF82-11154
Application Packet for Registration as a Code Enforcement Officer or Code Enf Officer In-training
Code Enforcement Officers - 219
Electronic File
F76-10796
St Bd Exam for Speech-Lang Pathology and Audiology - Report of Completed Internship Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10797
St Bd Exam for Speech-Lang Pathology and Audiology-Superv Resp Statement for Assts
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10798
Supervision Log - Speech-Language Pathology and Audiology
State Bd of Examiners Speech & Audiology - 129
Forms
F65-10710
Medical Radiologic Technologist Certification Application
Medical Radiologic Technologist Certif Prog 123
Forms
F76-10910
Late Renewal Form (Speech)
State Bd of Examiners Speech & Audiology - 129
Forms
F61-10684
Application for Contact Lens Disp Permit - Individual or Sole Proprietor
Contact Lens Dispensing Permit Program - 131
Forms
F76-11163
Felony/Misdemeanor Evaluation Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-11175
Clinical Deficiency Plan Completion of Training for Assistants Form
State Bd of Examiners Speech & Audiology - 129
Forms
Stock #4-25-lang Revised 10/25/2010
Page 109 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F76-11176
Rating Scale of Assistant's Performance Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-11177
Continuing Education--College University Course Work Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-13408
Alternate Supervision of an Assistant Request Plan
State Bd of Examiners Speech & Audiology - 129
Forms
F77-10801
ACP/AP Supervision Forms Packet (Texas State Board of Social Worker Examiners)
Tx State Bd of Social Worker Examiners - 93
Forms
F77-10802
Texas State Board of Social Worker Examiners - CEU Provider Appl Proc Packet
Tx State Bd of Social Worker Examiners - 93
Forms
F82-11153
Code Enforcement Officer Examination Request Form
Code Enforcement Officers - 186
Forms
F76-10909
Inactive Status Form (Speech)
State Bd of Examiners Speech & Audiology - 129
Forms
F64-10704
Massage Therapy Reg Program-Appl for School-Based Massage Therapy Instr
Massage Therapy Program - 122
Forms
F64-13388
Massage Therapy License Renewal Form
Massage Therapy Program - 122
Forms
F64-13023
Continuing Education Provider Application/Agreement
Massage Therapy Program - 122
Forms
F75-11220
Professional Licensing and Certification Division - Complaint Packet
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-11283
Professional Licensing and Certification Division Request to Withhold Personal Information Form
Professional Licensing and Certification - 98
Forms
F75-11360
Professional Licensing & Certification Division Complaint Form
Professional Licensing and Certification - 98
Forms
F75-11361
Professional Licensing & Certification Division Complaint General Release Form
Professional Licensing and Certification - 98
Forms
F76-10784
Audiology Course Work and Clinical Experience Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10787
Speech-Language Pathology Course Work and Clinical Experience Form
State Bd of Examiners Speech & Audiology - 129
Forms
F60-13340
Athletic Trainer Application Packet
Advisory Board of Athletic Trainers - 121
Forms
F76-10788
St Bd Exam for Speech-Lang Pathology and Audiology-Alt Meth for Assistant to Obtain Clinical Observ
State Bd of Examiners Speech & Audiology - 129
Forms
F61-10683
Application for Contact Lens Disp Permit-Corp or Other Business Entity
Contact Lens Dispensing Permit Program - 131
Forms
F76-10789
St Bd Exam for Speech-Lang Pathology and Audiology - Application Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10790
St Bd Exam for Speech-Lang Pathology and Audiology-Clinical Observ & Exp for Assts. Form
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10792
St Bd Exam for Speech-Lang Pathology and Audiology-Fitting & Disp of Hearing Instr Reg
State Bd of Examiners Speech & Audiology - 129
Forms
F76-10793
St Bd Exam for Speech-Lang Pathology and Audiology - Intern Plan & Agreement of Sup Form
State Bd of Examiners Speech & Audiology - 129
Forms
F64-10702
Massage Therapy Registration Program - Additional Program Application
Massage Therapy Program - 122
Forms
F76-10795
St Bd Exam for Speech-Lang Pathology and Audiology-Rec of Cont Educ Hrs Earned Used
State Bd of Examiners Speech & Audiology - 129
Forms
F64-10699
Massage Therapy Establishment Application
Massage Therapy Program - 122
Forms
F63-10698
Request to Establish a Registry for a Health-related Occupation
Health-Related Services Registry - 132
Forms
F75-10967
St Bd of Exam of Prof CounselorsSupervisory Agreement Form
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
Stock #4-25-lang Revised 10/25/2010
Page 110 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F64-10706
Massage Therapy Registration Program - Massage School/Ind Instructor Reg
Massage Therapy Program - 122
Forms
EF23-12994
Certified Food Manager (CFM) Test Site - Initial Renewal
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13014
Out-of-State Drug Distributor-Non-Prescription Drugs License Application-Initial, Renewal
Drugs & Food Safety Licensing - 89
Electronic File
E76-11556
Position Statement Relating to Continuing Education Credit for Coursework & AMA
State Bd of Examiners Speech & Audiology - 435
Electronic File
E76-11557
Position Statement Relating to Earned Degrees Appearing on Official Licenses for Speech-Lang Path-Au
State Bd of Examiners Speech & Audiology - 435
Electronic File
E76-11558
Position Statement Relating to Vestibular and Balancing Rehabilitiation
State Bd of Examiners Speech & Audiology - 435
Electronic File
E76-11559
Position Statement Relating to Newborn Hearing Screening
State Bd of Examiners Speech & Audiology - 435
Electronic File
EF23-13000
Device Manufacturer-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
E76-11560
Position Statement Relating to Hearing Aid Fitting for Adults
State Bd of Examiners Speech & Audiology - 435
Electronic File
E76-11561
Position Statement Regarding the need for an Amplification Device Candidacy Determination Audiologic
State Bd of Examiners Speech & Audiology - 435
Electronic File
EF23-12999
Out-of-State Drug Distributor-Prescription Drugs License Application-Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12998
Certified Food Manager (CFM) Food Handler Program - Initial, Renewal
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12997
Certified Food Manager (CFM) Examination Booklet Order - Test Sites
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13001
Device Distributor-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12995
Certified Food Manager (CFM) Test Site - Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
E76-11554
Policy and Management Responsibilities-Speech & Audiology Licensing
State Bd of Examiners Speech & Audiology - 435
Electronic File
EF23-12993
Certified Food Manager (CFM) Recertification - Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12992
Certified Food Manager (CFM) Recertification - Initial, Renewal
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12991
Certified Food Manager (CFM) Certification - Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12990
Certified Food Manager (CFM) Certification - Initial, Renewal, or Change of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12989
Certified Food Manager (CFM) Food Handler Program - Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12987
Certified Food Manager (CFM) Certificate - Renewal/Replacement Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12984
Salvage Establishments-Salvage Brokers-Initial, Renewal, or Change of Ownership (including legal
Food Licensing -146
Electronic File
EF23-12983
Salvage Establishments-Salvage Brokers-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12982
Bottled Water Operators Certificate of Competency Exam Application
Food Licensing -146
Electronic File
EF23-12981
Food Manufacturer-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12980
Food Warehouse Operator-Initial, Renewal, or Change of Ownership (including Legal entity)
Food Licensing -146
Electronic File
EF23-12979
Food Warehouse Operator-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12996
Certified Food Manager (CFM) Examination Booklet Order Program Sites
Drugs & Food Safety Licensing - 89
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 111 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E76-10908
Internship Procedures (Speech)
State Bd of Examiners Speech & Audiology - 208
Electronic File
EF23-13013
Multiple Products (Compressed Medical Gases-Nonprescr DrugFood-Devices)-Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
E71-11502
What Documents Do I Need to Submit? (Orthotics & Prosthetics Board)
Texas Board of Orthotics and Prosthetics - 239
Electronic File
EF23-13012
Multiple Products (Compressed Medical Gases-Nonprescr Drug)Initial, Renewal, or Change of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
E71-11503
Orthotics & Prosthetics Board Continuing Education (CE) Report Form
Texas Board of Orthotics and Prosthetics - 239
Electronic File
EF23-13011
Multiple Products (Nonprescription Drugs-Food-Devices)-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
E75-10780
St Bd of Examiners of Professional Counselors - Law
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
E75-10782
St Bd of Examiners of Professional Counselors Rules
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
E75-11362
Professional Licensing and Certification Division Complaint Form Instructions
Professional Licensing and Certification - 246
Electronic File
E75-11987
Abortion Facility Personnel Training on Recognizing and Reporting Child Abuse
Abortion Facility Licensing - 470
Electronic File
EF23-13010
Multiple Products (Nonprescription Drugs-Food-Devices)-Initial, Renewal, or Change of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13009
Drug Manufacturer-Prescription Drugs License Application-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
E76-11555
Position Statement Relating to Workload and Caseload Size in the Public Schools
State Bd of Examiners Speech & Audiology - 435
Electronic File
E76-10907
Internship License Application Process (Speech)
State Bd of Examiners Speech & Audiology - 208
Electronic File
E76-11563
Position Statement Relating to Laryngeal Videoendoscopy/Stroboscopy
State Bd of Examiners Speech & Audiology - 435
Electronic File
E76-11086
Texas Occupations Code and Board Rules
State Bd of Examiners for Speech & Audiology - 203
Electronic File
E76-11174
Instructions to Supervisor of an Intern (State Bd. Of Exam for Speech & Audiology)
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF23-13008
Drug Manufacturer-Prescription Drugs License App-Initial, Renewal, or Change of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
E76-11488
Board Rules (Speech, Language Pathology, Audiology)
State Bd of Examiners for Speech & Audiology - 203
Electronic File
E76-11489
Texas Occupations Code (Speech, Language Pathology, Audiology)
State Bd of Examiners for Speech & Audiology - 203
Electronic File
E76-11548
Position Statement for Supervising Assistants in Speech Language Pathology
State Bd of Examiners Speech & Audiology - 435
Electronic File
EF23-13007
Drug Manufacturer-Nonprescription Drugs License ApplicationMinor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13005
Drug Distributor-Prescription Drugs License Application-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13004
Drug Distributor-Prescription Drugs License App-Initial, Renewal, or Change of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
E76-11553
Program Accessibility
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF23-13003
Drug Distributor-Nonprescription Drugs License App-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13002
Drug Distributor-Nonprescription Drugs License App-Initial, Renewal, or Chg of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
E76-10785
St Bd Exam for Speech-Lang Pathology and Audiology -Texas Occupations Code
State Bd of Exam of Speech & Audiology - 213
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 112 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E77-11356
A Consumer's Guide to Social Work Licensing
Tx State Bd of Social Worker Examiners - 358
Electronic File
EF23-10603
Temporary Food Establishment Permit Application - 1 Event
Food Licensing -146
Electronic File
EF23-10597
Retail Food Operation Permit Application
Food Licensing -146
Electronic File
EF23-10505
Food Wholesaler License Application
Food Licensing -146
Electronic File
EF23-10504
Salvage Establishment/Salvage Broker License Application (Food Salvage)
Food Licensing -146
Electronic File
EF20-12926
Birthing Centers Initial Application
Facility Licensing - 761
Electronic File
EF20-12925
End-Stage Renal Disease Facility (ESRD) Initial Application
Facility Licensing - 761
Electronic File
EF20-12924
Abortion Facility Initial Application
Facility Licensing - 761
Electronic File
F64-10703
Massage Therapy Registration Program - Additional/New Main Location Appl
Massage Therapy Program - 122
Forms
EF20-12923
Ambulatory Surgical Center (ASC) Initial Application
Facility Licensing - 761
Electronic File
EF69-11967
Application for Continuing Education Program Approval - Fitting & Disp of Hearing Instruments
St. Comm. Examrs. In Fit & Disp. Hear Instr - 279
Electronic File
EF20-12922
End-Stage Renal Disease Facility (ESRD Renewal Application
Facility Licensing - 761
Electronic File
EF23-12978
Food Wholesaler License-Minor Amendment Change
Food Licensing -146
Electronic File
E77-10021
Continuing Education Requirements for Social Work Licensing
Tx State Bd of Social Worker Examiners - 358
Electronic File
EF23-10618
Tattoo Studio License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF20-12921
Abortion Facility Renewal Application
Facility Licensing - 761
Electronic File
EF20-12920
Ambulatory Surgical Center (ASC) Renewal Application
Facility Licensing - 761
Electronic File
EF20-12919
Birthing Centers Renewal Application
Facility Licensing - 761
Electronic File
EF20-12912
Final Construction Approval Form (Facility Licensing)
Facility Licensing - 752
Electronic File
E82-11168
Code Enforcement Officers Application Instructions Only
Code Enforcement Officers - 219
Electronic File
E82-11182
Code Enforcement Officers' Advisory Committee Rules
Tx State Bd of Social Worker Examiners - 93
Electronic File
E82-11183
Registered Sanitarian Advisory Committee Rules
Registered Sanitarian - 242
Electronic File
E82-11416
Continuing Education Requirement for Code Enforcement Officers
Code Enforcement Officers - 219
Electronic File
E82-11437
Information on Continuing Education for Professional Sanitarians in Texas
Registered Sanitarian - 242
Electronic File
EF20-12909
Self Certification Info Packet (Facility Licensing)
Facility Licensing - 752
Electronic File
EF20-12910
Plan Review Application (Facility Licensing)
Facility Licensing - 752
Electronic File
EF20-12911
Inspection Application (Facility Licensing)
Facility Licensing - 752
Electronic File
E76-13395
Assistant License-Application Process (Speech-Language Pathology and Audiology)
State Bd of Exam of Speech & Audiology - 213
Electronic File
EF23-12958
Certificate of Authority (Drugs & Food Safety Licensing)
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13006
Drug Manufacturer-Nonprescription Drugs License App-Initial, Renewal, or Chg of Ownership
Drugs & Food Safety Licensing - 89
Electronic File
E76-11564
Position Statement Relating to Services to Dysphagic Patients by Speech-Lang Pathologies
State Bd of Examiners Speech & Audiology - 435
Electronic File
E76-11575
Position Statement for Supervising Licensed Interns in Audiology
State Bd of Examiners Speech & Audiology - 435
Electronic File
E76-12587
Position Statement Relating to Licensure of Au.D. Student Externs
State Bd of Examiners Speech & Audiology - 435
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 113 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
EF23-12977
Food Wholesaler Registration-Initial, Renewal, or Change of Ownership (including legal entity)
Food Licensing -146
Electronic File
EF23-12976
Food Wholesaler Registration-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12975
Retail Food Operation-Childcare-School-Roadside Vendor-Mobile Food Vendor-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12974
Retail Food Operation-Food Establishment-Food Store-Minor Amendment Change
Food Licensing -146
Electronic File
EF23-12972
Food Establishment Inspection Application
Food Licensing -146
Electronic File
EF23-12971
Shellfish Processing Facility
Food Licensing -146
Electronic File
EF23-12970
Retail Temporary Food Establishment-Multiple Events
Food Licensing -146
Electronic File
EF23-12969
School Food Establishment Inspection Application
Food Licensing -146
Electronic File
EF23-10609
Multiple Product Licenses Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12967
Certificate of Freesale and Sanitation and/or Certificate of Origin
Food Licensing -146
Electronic File
EF23-10613
Tanning Facilities License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-12957
Certificate of Authority Minor Amendment (Drugs & Food Safety Licensing)
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10864
Salvage Establistment/Salvage Broker to Include Medical Devices License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10859
Childcare/School/Roadside Vendor/Mobile Unit Food Establishment Permit Application
Food Licensing -146
Electronic File
EF23-10858
Device Distributor License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10857
Bloodborne Pathogen Control Program Device Registration Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10856
Drug Distributor (Manufacturer) License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10855
Drug Distributor License Applications For Out of State Firms
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10854
Drug Distributor License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10853
Food Manufacturer License Application
Food Licensing -146
Electronic File
EF23-10621
Device Manufacturer License Application
Drugs & Food Safety Licensing - 89
Electronic File
EF23-10619
Body Piercing Studio License Application
Drugs & Food Safety Licensing - 89
Electronic File
E76-11562
Position Statement Relating to Utilization & Employment of SpeechLang Pathology Supportive Personne
State Bd of Examiners Speech & Audiology - 435
Electronic File
EF23-12968
Crabmeat Processing Facility
Food Licensing -146
Electronic File
EF47-10625
In-State Frozen Dessert Manufacturer Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
E49-11733
Suppliers for Germicides and Law Labels
Prod Safety - 396
Electronic File
E18-11310
Asbestos Regulatory Clarifications (ARCs)
PSQA-Envir Hazards - 632
Electronic File
EF49-11290
Application for Volatile Chemical Sales Permit
Abusive Volatile Chemicals Program - 192
Electronic File
EF47-10629
Grade "A" Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
EF47-10628
Out-of-State Milk or Dairy Products Processor Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
E20-12388
Youth Camp Matrix
Environ/Consumer Safety 616
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 114 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
EF47-10627
Out-of-State Frozen Dessert Manufacturer Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
E20-12398
Youth Camp Approved Training Programs (Sexual Abuse & Child Molestation)
Environ/Consumer Safety 616
Electronic File
E02-13442
Texas Occ Code Title 3 Subtitle G Chapt 403 Licensed Dyslexia Practitioners/Licen Dyslexia Therapist
Dyslexia Therapist - 877
Electronic File
E23-10614
Rules for Licensure of Tanning Facilities
Food & Drug SafetyLicensing - 252
Electronic File
EF49-12097
Germicidal Treatment Application Packet
Chem & Prod Sfty(Bedding) - 772
Electronic File
E23-10622
Rules for Licensure of Device Distributors and Manufacturers
Food & Drug SafetyLicensing - 252
Electronic File
E76-11552
Public Participation in Board Meetings-Speech & Audiology Licensing
State Bd of Exam of Speech & Audiology - 213
Electronic File
E23-12973
Mobile Food Vendor Checklist
Food Licensing -146
Electronic File
EF23-13015
Out-of-State Drug Distributor-Non-Prescription Drugs License Application-Minor Amendment
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13021
Tanning Facilities-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
EF23-13020
Transfer and/or Receiving Station
Drugs & Food Safety Licensing - 89
Electronic File
E23-13039
Bottled and Vended Water Operator Certification Manual
PSQA-Foods - 789
Electronic File
E23-13424
Initial Internet Examination Development
Drugs & Food Safety Licensing - 89
Electronic File
EF47-10626
In-State Milk or Dairy Products Processor Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
E02-12557
Personal Emergency Response Systems Provider Program Rules, 25 TAC Chapt 140, Subchapt B
PERS Providers - 686
Electronic File
EF67-12090
Statement of Continuing Education Form for Opticians
Optician's Registry Program - 502
Electronic File
EF67-10722
Opticians Registry - Application for Optician Registration
Optician's Registry Program - 502
Electronic File
EF66-13412
Supervising Midwife/Apprentice Complaint Disclosure Form
Midwifery Program - 861
Electronic File
EF66-10717
Midwife Informed Choice and Disclosure Statement
Midwifery Program - 671
Electronic File
EF65-10711
Application for Hardship Exemption - Medical Radiologic Technologist
Medical Radiologic Techn. Certif Prog - 842
Electronic File
EF64-13397
Massage Therapy Educational Program Application for Basic 500Hour Program
Massage Therapy Program - 206
Electronic File
E02-12215
Licensed Chemical Dependency Counselor Handbook
Licensed Chemical Dependency Counselor 535
Electronic File
EF64-13389
Massage Therapy Instructor License Renewal Form
Massage Therapy Program - 206
Electronic File
EF49-11742
Bedding License Application
Chem & Prod Sfty(Bedding) - 772
Electronic File
EF64-13023
Continuing Education Provider Application/Agreement
Massage Therapy Program - 206
Electronic File
EF23-13022
Tattoo-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
E02-12558
Personal Emergency Response Systems Provider Program Law, Texas HSC 781
PERS Providers - 687
Electronic File
EF61-10684
Application for Contact Lens Disp Permit - Individual or Sole Proprietor
Contact Lens Dispensing Permit Program - 164
Electronic File
EF61-10683
Application for Contact Lens Dispensing Permit - Corporation or Other Business Entity
Contact Lens Dispensing Permit Program - 164
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 115 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
EF60-13340
Athletic Trainer Application Packet
Advisory Board of Athletic Trainers - 207
Electronic File
E02-12783
Licensed Chemical Dependency Counselor Program Rules
Licensed Chemical Dependency Counselor 717
Electronic File
E02-13423
Licensed Chemical Dependency Counselor Program Law
Licensed Chemical Dependency Counselor 868
Electronic File
EF60-12125
Athletic Trainer License Renewal Form
Advisory Board of Athletic Trainers - 207
Electronic File
E02-13441
Rules Relating to the Licensing and Regulation of Dyslexia Therapists and Dyslexia Practitioners
Dyslexia Therapist - 877
Electronic File
EF64-13388
Massage Therapy License Renewal Form
Massage Therapy Program - 206
Electronic File
E49-12370
Germicidal Treatment (GT) Log Book
Prod Safety - 396
Electronic File
E71-11197
Orthotists and Prosthetists Occupations Code
Texas Board of Orthotics and Prosthetics - 239
Electronic File
E71-11067
Acquiring Licensure as a Uniquely Qualified Person
Texas Board of Orthotics and Prosthetics - 239
Electronic File
E69-13311
Guidelines for Review by License Holder from Another State, TOC, Chapter 402, Sec. 402.209
St. Comm. Examrs. In Fit & Disp. Hear Instr - 837
Electronic File
EF23-13016
Out-of-State Drug Distributor-Prescription Drugs License Application-Initial, Renewal
Drugs & Food Safety Licensing - 89
Electronic File
E60-13421
Advisory Board of Athletic Trainers Law
Advisory Board of Athletic Trainers - 866
Electronic File
EF23-13018
Producer Dairy
Drugs & Food Safety Licensing - 89
Electronic File
E66-13024
Required Reading and Textbooks
Midwifery Program - 784
Electronic File
E66-10720
The Texas Midwifery Basic Information and Instructor Manual
Midwifery Program - 671
Electronic File
E66-10555
Texas Midwifery Board Midwifery Rules
Midwifery Program - 671
Electronic File
E49-11737
A Listing of Bedding Items Regulated in the State of Texas
Prod Safety - 396
Electronic File
E71-11198
Orthotics and Prosthetics Board Rules
Texas Bd. Of Orthotics & Prosthetics - 241
Electronic File
E49-11739
Label for Items Made of All New Material
Prod Safety - 396
Electronic File
E66-13413
Apprentice/Student Policy
Midwifery Program - 861
Electronic File
E64-11749
Massage Therapy General Information Brochure
Massage Therapy Program - 206
Electronic File
EF23-13019
Retail Raw Dairy
Drugs & Food Safety Licensing - 89
Electronic File
E49-12372
Renovator Label
Prod Safety - 396
Electronic File
E60-10904
Candidate Information - Texas Athletic Trainer Licensure Examinations
Advisory Board of Athletic Trainers - 207
Electronic File
E49-11736
Processed Filled Material Label
Prod Safety - 396
Electronic File
E64-11100
Texas Occupations Code (Massage Therapy)
Massage Therapy Program - 206
Electronic File
EF47-10624
Milk Tank Truck Permit Application
Drugs & Food Safety Licensing - 89
Electronic File
E62-12044
History of Council on Sex Offender Treatment
Council on Sex Offender Treatment - 478
Electronic File
E61-10943
Enforcement and Investigation Policy (Contact Lens Dispensing)
Contact Lens Dispensing Permit Program - 164
Electronic File
E60-13420
Advisory Board of Athletic Trainers Rules
Advisory Board of Athletic Trainers - 867
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 116 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E49-11738
Germicidal Treatment Label
Prod Safety - 396
Electronic File
EF23-13017
Body Piercing Studio-Minor Amendment Change
Drugs & Food Safety Licensing - 89
Electronic File
Lifestyles & Health / Estilos de vida y Salud E10-75
Congratulations, Your Life Is About to Change for the Better (African American women)
Osteoporosis - 225
Electronic File
E10-76
Remember When Your Mother Used to Say "Just Drink This--It's Good For You?" (Asian women)
Osteoporosis - 225
Electronic File
E33-11383
Health Observances Calendar
Web Technology Services - 275
Electronic File
E10-15F
ABCs of Health - High Blood Pressure
Adult Health - 231
Electronic File
E44-10946
Your Life is About to Change for the Better (general audiences)
Osteoporosis - 225
Electronic File
E81-11195
Texas Plan to Reduce Cardiovascular Disease and Stroke
Cardiovascular Health and Wellness - 193
Electronic File
E81-11194
Texas Chronic Disease Burden Report
Chronic Disease - 859
Electronic File
E81-11381
Texas Wellness Calendar
Cardiovascular Health and Wellness - 274
Electronic File
E07-11640
Important First Steps
Epidemiology/Injury Surveillance - 351
Electronic File
E10-15J
ABCs of Health - Tobacco
Adult Health - 231
Electronic File
16-11164
Texas Risk Factor Report
Behavioral Risk Factor Surveillance System - 222
Newsletters
E10-15K
ABCs of Health - Stress
Adult Health - 231
Electronic File
E10-15D
ABCs of Health - Cancer
Adult Health - 231
Electronic File
E16-11164
Texas Risk Factor Report
Behavioral Risk Factor Surveillance System - 223
Electronic Newsletter/Magazine
Literature-contracts / Publicaciones--contractos E29-12491
General Provisons (Professional Services) 2007
Client Services Contracting - 437
Electronic File
E29-12425
General Provisions - Core/Subrecipient
Client Services Contracting - 437
Electronic File
E29-12426
General Provisions - Core/Vendor
Client Services Contracting - 437
Electronic File
E29-12427
Substance Abuse Additional General Provisions - Subrecipient
Client Services Contracting - 437
Electronic File
E29-12428
Substance Abuse Additional General Provisions - Vendor
Client Services Contracting - 437
Electronic File
Long Term Care Facilities / Centros de atencion a largo plazo E4-20-8
Alzheimer's Disease, Aging, Long Term Care, Infection Control, Fire Safety, Back Safety
Audiovisual Library - 196
Electronic File
E25-13043
Directors of Nursing (DON) in Texas Long Term Care Nursing Facilities
TX Ctr Nursing Workforce - 673
Electronic File
E25-13045
Safe Patient Handling in Texas Long Term Care Nursing Facilities
TX Ctr Nursing Workforce - 673
Electronic File
E25-13046
Staff Compensation and Benefits in Texas Long Term Care Nursing Faciliites
TX Ctr Nursing Workforce - 673
Electronic File
E25-13047
2008 Long Term Care Nurse Staffing Study (LTC NSS) Study Design and Methods
TX Ctr Nursing Workforce - 673
Electronic File
E25-13048
Turnover and Vacancy Rates in Texas Long Term Care Nursing Faciliites for RNs and LVNs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13049
Turnover and Vacancy Rates in Texas Long Term Care Nursing Faciliites for Unlicensed Nursing Staff
TX Ctr Nursing Workforce - 673
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 117 of 221
Stock Number E25-13064
Title
Format
Source (must print Contact List to have all necessary information)
2008 Long Term Care Nurse Staffing Survey Highlights of Findings and Recommendations
TX Ctr Nursing Workforce - 673
Electronic File
Lungs & Respiratory System / Pulmones y el sistema respiratorio E04-12094
The Burden of Asthma in Texas 2000-2005 (Texas Asthma Report)
Adult Health - 231
Electronic File
E09-13459
Texas Influenza Sureveillance Handbook
Infectious Disease - 881
Electronic File
F68-10730
Respiratory Care Practitioners Certif Program - Late Renewal Deficiency Notification
Respiratory Care Pract. Certif. Program - 843
Forms
F68-10726
Respiratory Care Practitioners Application Packet
Respiratory Care Pract. Certif. Program - 843
Forms
68-10725
Respiratory Care Practitioners Bulletin - A Newsletter for Resp Care Practitioners
Respiratory Care Pract. Certif. Program - 843
Newsletters
F68-10729
Respiratory Care Practitioners Certification Program - Exam Score Release Form
Respiratory Care Pract. Certif. Program - 843
Forms
E10-15J
ABCs of Health - Tobacco
Adult Health - 231
Electronic File
Lyme Disease / Enfermedad de Lyme EF15-11877
Lyme Disease Case Investigation Form
Zoonosis - 448
Electronic File
E7-35
Lyme Disease
Zoonosis - 376
Electronic File
EAG-11
DSHS Location Map (Austin DSHS Facilities Information Map)
Web Technology Services - 81
Electronic File
AG-11
DSHS Location Map (Austin DSHS Facilities Information Map)
Executive & Staff Operations - 39
Maps
EAG-39
DSHS Facilities Location Map (DSHS Main Campus Map)
Web Technology Services - 82
Electronic File
AG-39
DSHS Facilities Location Map (DSHS Main Campus Map)
Executive & Staff Operations - 39
Maps
Maps / Mapas
Massage Therapy / Terapia de masaje F64-10704
Massage Therapy Reg Program-Appl for School-Based Massage Therapy Instr
Massage Therapy Program - 122
Forms
F64-10706
Massage Therapy Registration Program - Massage School/Ind Instructor Reg
Massage Therapy Program - 122
Forms
F64-10703
Massage Therapy Registration Program - Additional/New Main Location Appl
Massage Therapy Program - 122
Forms
F64-10702
Massage Therapy Registration Program - Additional Program Application
Massage Therapy Program - 122
Forms
F64-10701
Massage Therapy Registration Application
Massage Therapy Program - 122
Forms
F64-10699
Massage Therapy Establishment Application
Massage Therapy Program - 122
Forms
E64-11100
Texas Occupations Code (Massage Therapy)
Massage Therapy Program - 206
Electronic File
F64-10707
Massage Therapy Registration Program - Seminar/Workshop Application
Massage Therapy Program - 122
Forms
Medicare/Medicaid / Medicare/Medicaid MTP-210
Medicaid-Free Rides (wallet card)
Texas Health Steps - 24
Small card
E30-11990
Centralized Billing System Handbook (restricted to Local Health Depts)
Accounting-Revenue Mgmt- 479
Electronic File
EF12-12105
PPD Agreement for Texas Health Steps Providers
Infectious Disease Control Unit - TB - 320
Electronic File
EOPE-001
Online Provider Education flyer
Texas Health Steps - 284
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 118 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
CIHCP Form 105
CIHCP Monthly Financial / Activity Report (County Indigent Health Care)
Indigent Health Program 421
Electronic File
CIHCP Form 106
Eligibility Dispute Resolution Request (County Indigent Health Care)
Indigent Health Program 421
Electronic File
CIHCP Form 111
Payment Rate Request (County Indigent Health Care)
Indigent Health Program 421
Electronic File
CIHCP Form 500
Request for State Assistance Funds (County Indigent Health Care)
Indigent Health Program 421
Electronic File
E08-13373
First Dental Home Visits-Required Elements
Oral Health - 597
Electronic File
E25-11033
Texas Health Facts
Center for Health Statistics - 191
Electronic File
E25-12472
Your HMO Quality Check-up (Medicaid Reports)
Tx Hlth Care Info Collection - 406
Electronic File
E25-12473
Your HMO Quality Check-up (Medicare Reports)
Tx Hlth Care Info Collection - 406
Electronic File
EMTP-610
Medicaid-Free Rides (sticker)
Texas Health Steps - 24
Stickers
Electronic File
Medicine / Medicina E05-03877
Chest Syndrome
Newborn Screening - 313
E05-06836
Newborn Screening Program Practitioner's Guide
Newborn Screening - 68
Electronic File
E05-03945
Sickle Cell Anemia: A Parent's Guide For the School Age Child
Newborn Screening - 313
Electronic File
E05-03880
Aplastic Crisis
Newborn Screening - 313
Electronic File
E05-10103
Hemoglobin E
Newborn Screening - 313
Electronic File
E05-03878
Splenic Sequestration Crisis
Newborn Screening - 313
Electronic File
E05-03879
Priapism
Newborn Screening - 313
Electronic File
E05-10119
Sickle Cell Disease: A Resource For the Educator
Newborn Screening - 313
Electronic File
E05-10378
Sickle Cell Disease and Sickle Cell Trait
Newborn Screening - 313
Electronic File
E05-10579
Sickle Cell Dis. in Children & Adolescents: Diagn., Gdlines for Comp. Care & Protocols for Mgt.
Newborn Screening - 313
Electronic File
E05-10580
Schedule of Assessment for PKU
Newborn Screening - 281
Electronic File
E05-10582
The Young Woman with Mild Hyperphenylalanemia
Newborn Screening - 281
Electronic File
E05-03875
Hemoglobin C Disease
Newborn Screening - 313
Electronic File
E05-10581
The Young Woman with PKU
Newborn Screening - 313
Electronic File
226-7
Healing Arts Screening (Excerpt from 25 Texas Administrative Code Section 289.226(w)(4)
Radiation Control - 326
Electronic File
E05-10583
Schedule of Assessment for Galactosemia
Newborn Screening - 318
Electronic File
62-10692
Tx Resource: the Official Newsletter of the Council on Sex Offender Treatment
Council on Sex Offender Treatment - 118
Newsletters
05-10779
Sickle Cell Disease Affects Us All - Where Are Your Roots? (Limit 5)
Newborn Screening - 136
Posters
05-12258
1-3-6 Month Practioner's Guide
PACT-Health Steps - 782
Electronic File
1-159
Texas Newborn Screening Program Bookmark (Limit 5)
Warehouse
Bookmarks
16-4
Know Your Rights #1 (available from DSHS warehouse only)
Warehouse
Posters
E105-12315
TIMA Overview (Texas Implementation of Medical Algorithms)
TIMA-Patient/Family Ed 586
Electronic File
25TAC601.8(1)
Disclosure and Consent for Hysterectomy
Health Facility Licensing 339
Forms
59-11509
There's No Excuse for Overuse (The Anti-B's!)
Infectious Disease - 35
Posters
59-11510
We're the Anti-B's (coloring sheet)
Infectious Disease - 35
Coloring Books
Stock #4-25-lang Revised 10/25/2010
Page 119 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E05-03874
Pain in the Child with Sickle Cell Disease
Newborn Screening - 313
Electronic File
BirthDefects95
Report of Birth Defects Among 1995 Deliveries
Birth Defects Epi - 210
Electronic File
DrugFormulary
Drug Formulary (DSHS and DADS publication)
Mental Health & Substance Electronic File Abuse - 521
E05-02233
Hypothyroidism and Your Infant
Newborn Screening - 317
Electronic File
E05-03870
Hemoglobin Sickle C Disease
Newborn Screening - 313
Electronic File
E05-03871
Sickle Beta Zero Thalassemia
Newborn Screening - 313
Electronic File
E05-03872
Sickle Beta+ Thalassemia
Newborn Screening - 313
Electronic File
E05-03873
Sickle Cell Anemia and Stroke
Newborn Screening - 313
Electronic File
05-06442
A Sickle Cell Coloring Book (Limit 5)
Newborn Screening - 136
Coloring Books
EPSDT-12
Checkups Poster (Texas Health Steps)
Texas Health Steps - 24
Electronic File
E05-10586
Questions You May Have for Your Genetic Specialist
Genetics Services - 69
Electronic File
E59-12229
What You Should Know about using Antibiotics
Infectious Disease - 602
Electronic File
E6-223
Pesticide Exposure Surveillance in Texas (brochure)
Pesticide Exposure Surv (PEST) - 452
Electronic File
E6-240
Report of Birth Defects among 1999-2001 Deliveries
Birth Defects Epi - 210
Electronic File
E6-53
Antibiotic Resistance (Antibiotics Aren't Always the Answer)
Infectious Disease - 621
Electronic File
E80-10942
Indigent Health Care Program Handbook
Indigent Health Program 421
Electronic File
EF01-11421
Department of State Health Services Standard Out-of-Hospital Do Not Resuscitate Order (DNR)
EMS - 292
Electronic File
EF105-12316
Symptom and Side Effects Monitoring Sheet: Schizophrenia
TIMA-Patient/Family Ed 586
Electronic File
EF105-12317
Symptom and Side Effects Monitoring Sheet- Depression
TIMA-Patient/Family Ed 586
Electronic File
EF105-12318
Symptom and Side Effects Monitoring Sheet-Bipolar Disorder (Mania)
TIMA-Patient/Family Ed 586
Electronic File
EL-865
Quality Care: Client Services Standards for Public Health and Community Clinics (Publ # 21-10865)
Public Health Nursing - 263 Electronic File
EM-76
Report of Otological Examination
Audiology - 440
E59-12226
Antibiotic Resistance Questions and Answers
Infectious Disease - 602
Electronic File
EPB-109
Physician Reference on Follow-up Testing and Case Management
Childhood Lead Poisoning - 385
Electronic File
E59-11769
Appropriate Antibiotic Use Campaign - PTA Media Kit
Infectious Disease - 400
Electronic File
EPSDT-13
Visits to the Doctor and Dentist (Appointment Education Poster (16" x 20")
Texas Health Steps - 24
Posters
EPSDT-15
Case Management for Children and Pregnant Women (Case Management Poster) 8-1/2" x 11"
Texas Health Steps - 24
Electronic File
F105-12316
Symptom and Side Effects Monitoring Sheet: Schizophrenia
TIMA-Patient/Family Ed 585
Forms
F105-12317
Symptom and Side Effects Monitoring Sheet- Depression
TIMA-Patient/Family Ed 585
Forms
F105-12318
Symptom and Side Effects Monitoring Sheet-Bipolar Disorder (Mania)
TIMA-Patient/Family Ed 585
Forms
F62-10689
Reg Sex Offender Treatment Prov/Affiliate Sex Offender Treatment Prov Appl
Council on Sex Offender Treatment - 118
Forms
F62-10690
Sexual Abuser Treatment Program Questionnaire
Council on Sex Offender Treatment - 118
Forms
F63-10696
Registry for Health-related Occupations Application Form
Health-Related Services Registry - 132
Forms
Stock #4-25-lang Revised 10/25/2010
Electronic File
Page 120 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F70-10737
Texas Board of Licensure for Professional Medical Physicists License Appl Packet
Tx Bd Licensure for Prof. Medical Physicists - 134
Forms
PB-104
Physician Checklist for Parent Education Topics
Warehouse
Forms
Psychotropic
Psychotropic Medication Utilization Parameters for Foster Children (only web version is available)
Medical Director/Behavioral Health - 520
Electronic File
RioGran96
1996 Birth Defects in the Lower Rio Grande Valley-A Special Report
Birth Defects Epi - 210
Electronic File
EPB-104
Physician Checklist for Parent Education Topics
Childhood Lead Poisoning - 385
Electronic File
E25-12443
Preventable Hospitalizations in Texas, 2002
Tx Hlth Care Info Collection - 301
Electronic File
E10-10662
Texas Cancer Registry Quality and Assurance Flyer
Cancer Epi/Surv - 111
Electronic File
E105-12320
Medication Benefit Sheet: Mania
TIMA-Patient/Family Ed 586
Electronic File
E105-12321
Medication Benefit Sheet: Anxiety
TIMA-Patient/Family Ed 586
Electronic File
E105-12322
Medication Benefit Sheet: Psychosis
TIMA-Patient/Family Ed 586
Electronic File
E1-206
Congenital Adrenal Hyperplasia: A Handbook for Parents
Newborn Screening - 282
Electronic File
E21-10865
Quality Care: Client Services Standards for Public Health and Community Clinics
Public Health Nursing - 263 Electronic File
E25-10992
Selected Health Professions in Texas
Hlth Prof Resource Ctr 662
Electronic File
E25-11033
Texas Health Facts
Center for Health Statistics - 191
Electronic File
E25-11399
The State of Telemedicine and Telehealth in Texas
Statewide Health Electronic File Coordinating Council - 666
E25-11847
Supply Trends Among Licensed Health Professions, Texas
Hlth Prof Resource Ctr 767
Electronic File
E25-12400
A Workforce Study of Medical, Nursing and Mental Health Professions in Texas
Hlth Prof Resource Ctr 661
Electronic File
E25-12401
Texas Health Care Workforce Supply Trends
Hlth Prof Resource Ctr 661
Electronic File
E59-12228
Antibiotic Use Do's and Don'ts
Infectious Disease - 602
Electronic File
E25-12442
Indicators of Inpatient Care in Texas Hospitals, 2004
Tx Hlth Care Info Collection - 301
Electronic File
E05-12258
1-3-6 Month Practioner's Guide
PACT-Health Steps - 554
Electronic File
E25-12778
Highlights: The Supply of Pediatricians in Texas - 2006
E25TAC601.4(a)
Disclosure and Consent for Medical and Surgical Procedures
Health Facility Licensing 635
Electronic File
E25TAC601.5(1)
Disclosure and Consent for Radiation Therapy
Health Facility Licensing 635
Electronic File
E25TAC601.8(1)
Disclosure and Consent for Hysterectomy
Health Facility Licensing 635
Electronic File
E45-11265
Glycemic Control Algorithm for Type 2 Diabetes Mellitus in Children and Adults
Texas Diabetes Council 197
Electronic File
E58-10772
Report of Birth Defects Among 1996-1997 Deliveries
Birth Defects Epi - 210
Electronic File
E58-11857
Report of Birth Defects Among 1999-2000 Deliveries
Birth Defects Epi - 210
Electronic File
E58-12309
Report of Birth Defects among 1999-2002 Deliveries
Birth Defects Epi - 210
Electronic File
E59-11312
Home vs. Hospital Care Precautions for Antibiotic Resistant Bacteria
Infectious Disease - 400
Electronic File
E59-11509
There's No Excuse for Overuse (The Anti-B's!)
Infectious Disease - 602
Posters
E59-11510
The Anti-Bs Coloring Sheet - "We're the Anti-Bs"
Infectious Disease - 602
Coloring Books
Stock #4-25-lang Revised 10/25/2010
Electronic File
Page 121 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E59-11511
A Guide for Parents - Get Smart about Antibiotics
Infectious Disease - 602
Electronic File
E25-12439
Guide to Texas HMO Quality
Tx Hlth Care Info Collection - 406
Electronic File
E105-12319
Medication Benefit Sheet: Depression
TIMA-Patient/Family Ed 586
Electronic File
05-03113
Endocrinology Follow Up Post Card (Limit 5)
Newborn Screening - 136
Postcards
Men - Health & Hygiene / Hombres--salud e higiene E44-10831
1998-99 Biennial Report of the Osteoporosis Advisory Committee
Osteoporosis - 225
Electronic File
E44-11185
Prostate Cancer Advisory Committee Biennial Report
Adult Health - 231
Electronic File
E10-53
Living With Your Own Decision: Facts about Prostate Cancer Screening for the Hispanic Man
Adult Health - 231
Electronic File
E10-52
Is Prostate Cancer Screening For Me?
Adult Health - 231
Electronic File
E10-15K
ABCs of Health - Stress
Adult Health - 231
Electronic File
E10-10921
Prostate Cancer in Texas
Cancer Epi/Surv - 111
Electronic File
E05-03879
Priapism
Newborn Screening - 313
Electronic File
E10-51
Prostate Cancer Screening: Facts for the African American Man
Adult Health - 231
Electronic File
Mental Health / Salud mental 62-10692
Tx Resource: the Official Newsletter of the Council on Sex Offender Treatment
Council on Sex Offender Treatment - 118
Newsletters
E105-12320
Medication Benefit Sheet: Mania
TIMA-Patient/Family Ed 586
Electronic File
E105-12319
Medication Benefit Sheet: Depression
TIMA-Patient/Family Ed 586
Electronic File
E105-12315
TIMA Overview (Texas Implementation of Medical Algorithms)
TIMA-Patient/Family Ed 586
Electronic File
E02-12527
Licensed Mental Health Professionals in Texas-A Fact Sheet for Consumers
Professional Licensing and Certification - 677
Electronic File
DrugFormulary
Drug Formulary (DSHS and DADS publication)
Mental Health & Substance Electronic File Abuse - 521
B-103
Kris, Are You Sad? (Limit 1)
Warehouse
Coloring Books
111-13173
Texas P.R.I.D.E. Newsletter
PRIDE Crisis Counseling 808
Newsletters
75-10783
The Examiner
Tx St. Bd of Examiners of Prof Counselors - 128
Newsletters
EB-102
Brain Function Sheet: Depression
TIMA-Patient/Family Ed 586
Electronic File
EB-101
Brain Function Sheet: Bipolar Disorder
TIMA-Patient/Family Ed 586
Electronic File
B-200
Claire's Story
Warehouse
DVD
B-100
Brain Function Sheet: Schizophrenia (Limit 1)
Warehouse
Fact Sheets
E25-13433
A Guide to Workforce Data on Mental Health Professions
Hlth Prof Resource Ctr 662
Electronic File
EB-100
Brain Function Fact Sheet: Schizophrenia
TIMA-Patient/Family Ed 586
Electronic File
E75-11652
What to Expect from your Licensed Professional Counselor (LPC brochure)
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
E75-10783
The Examiner
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic Newsletter/Magazine
B-102
Brain Function Sheet: Depression (Limit 1)
Warehouse
Fact Sheets
Stock #4-25-lang Revised 10/25/2010
Page 122 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E75-10780
St Bd of Examiners of Professional Counselors - Law
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
E105-12321
Medication Benefit Sheet: Anxiety
TIMA-Patient/Family Ed 586
Electronic File
E25-12347
Highlights of "The Supply of Mental Health Professionals in Texas"
Hlth Prof Resource Ctr 662
Electronic File
E16-9
Handbook of Consumer Rights Mental Health
Mental Hlth-Substance Abuse - 670
Electronic File
E111-13296
CCP Close Out Brochure
PRIDE Crisis Counseling 813
Electronic File
E111-13203
Helping Children Recover from the Emotional Aftermath of a Disaster
PRIDE Crisis Counseling 813
Electronic File
E111-13202
Helping the Elderly Recover from the Emotional Aftermath of a Disaster
PRIDE Crisis Counseling 813
Electronic File
E105-12328
Roadmap to Recovery Part 2 (Student handout)
TIMA-Patient/Family Ed 586
Electronic File
E75-10782
St Bd of Examiners of Professional Counselors Rules
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
E111-13201
Recovering from the Emotional Aftermath of a Disaster
PRIDE Crisis Counseling 813
Electronic File
E105-12326
Suggested Techniques for Coping with Persistent Symptoms
TIMA-Patient/Family Ed 586
Electronic File
E105-12322
Medication Benefit Sheet: Psychosis
TIMA-Patient/Family Ed 586
Electronic File
E105-12327
Roadmap to Recovery Part 1 (Student handout)
TIMA-Patient/Family Ed 586
Electronic File
E105-12329
Roadmap to Recovery Part 1 (Facilitator Guide)
TIMA-Patient/Family Ed 586
Electronic File
E105-12330
Roadmap to Recovery Part 2 (Facilitator Guide)
TIMA-Patient/Family Ed 586
Electronic File
E105-12331
Consumer to Consumer Discussion Materials (Peer Facilitator Guide)
TIMA-Patient/Family Ed 586
Electronic File
E106-12932
Behavorial Health News Brief
MHSA Decision Support 763
Electronic Newsletter/Magazine
E111-13200
No One Who Sees a Disaster is Untouched by it
PRIDE Crisis Counseling 813
Electronic File
F75-11220
Professional Licensing and Certification Division - Complaint Packet
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
EB-105
Most Children Who Are Depressed Won't Tell You They Feel Sad
CMAP-Patient/Family Ed 654
Electronic File
F62-10689
Reg Sex Offender Treatment Prov/Affiliate Sex Offender Treatment Prov Appl
Council on Sex Offender Treatment - 118
Forms
MHRS9-7
Consent to Treatment with Psychoactive Medication
Hospitals Section - 515
Forms
F105-12316
Symptom and Side Effects Monitoring Sheet: Schizophrenia
TIMA-Patient/Family Ed 585
Forms
F105-12318
Symptom and Side Effects Monitoring Sheet-Bipolar Disorder (Mania)
TIMA-Patient/Family Ed 585
Forms
EB-104
Life Can Be Tough
CMAP-Patient/Family Ed 654
Electronic File
Psychotropic
Psychotropic Medication Utilization Parameters for Foster Children (only web version is available)
Medical Director/Behavioral Health - 520
Electronic File
MH-Laws
Texas Laws for Mental Health
Mental Health - 704
Electronic File
EF105-12318
Symptom and Side Effects Monitoring Sheet-Bipolar Disorder (Mania)
TIMA-Patient/Family Ed 586
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 123 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F75-10757
Licensed Professional Counselor - Application Packet
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
EF105-12317
Symptom and Side Effects Monitoring Sheet- Depression
TIMA-Patient/Family Ed 586
Electronic File
EF75-10757
Licensed Professional Counselor - Application Packet
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF105-12316
Symptom and Side Effects Monitoring Sheet: Schizophrenia
TIMA-Patient/Family Ed 586
Electronic File
F75-10759
St Bd Exam of Professional Counselors - Counselor Cont Education Declaration
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
EF75-10781
St Bd of Examiners of Prof Counselors-Pre-Approved Cont Educ Prov Appl
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EMH-9
The Little Dinosaur Named Wilbur (Bill of Rights for Children)
Mental Hlth-Substance Abuse - 670
Electronic File
MH-8
Mental Health Privacy Notice
Prog Coord, Policy, Innov - 364
Electronic File
MH-1
Handbook of Consumer Rights Mental Health
Mental Health - 499
Electronic File
MH-7
New Freedom Summit-Transforming Mental Health in Texas
Mental Health - 499
Electronic File
MH-6
Identifying Best Practices in Public Housing for People Who are Homeless & Have a Mental Disability
Mental Health - 499
Electronic File
MH-5
Recovering from the Emotional Aftermath of a Disaster
Mental Health - 499
Electronic File
F62-10690
Sexual Abuser Treatment Program Questionnaire
Council on Sex Offender Treatment - 118
Forms
EMH-10
Teen's Bill of Rights (mental health)
Mental Hlth-Substance Abuse - 670
Electronic File
EMH-11
Patient's Bill of Rights (mental health)
Mental Hlth-Substance Abuse - 670
Electronic File
EF75-11220
Professional Licensing and Certification Division - Complaint Packet
Professional Licensing and Certification - 246
Electronic File
F75-10781
St Bd of Examiners of Prof Counselors-Pre-Approved Cont Educ Prov Appl
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
MH-2
Taking Care of Your Mental Health
Mental Health - 499
Electronic File
EB-106
Does My Child Have an Attention Disorder?
CMAP-Patient/Family Ed 655
Electronic File
MH-3
Helping Texas Communities When Disaster Strikes
Mental Health - 499
Electronic File
MH-4
Texas Crisis Consortium Brochure
Mental Health - 499
Electronic File
F105-12317
Symptom and Side Effects Monitoring Sheet- Depression
TIMA-Patient/Family Ed 585
Forms
TCADA-55
Characteristics of Substance Abuse Clients in the State Mental Hospitals & Clients in Community-Base
Mental Hlth/Sub Abuse496
Electronic File
EB-103
Kris, Are You Sad? (coloring book)
CMAP-Patient/Family Ed 654
Electronic File
Mental Retardation / Retraso mental DrugFormulary
Drug Formulary (DSHS and DADS publication)
Mental Health & Substance Electronic File Abuse - 521
MH-6
Identifying Best Practices in Public Housing for People Who are Homeless & Have a Mental Disability
Mental Health - 499
Electronic File
Minority Health / Salud de minorias E4-20-5
Spanish Language Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E24-13367
Annual Report Promotor(a) or Community Health Worker (CHW) Training and Certification Advisory 2009
Community Hlth Wrkr 851
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 124 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E25-11420
Healthy People 2000 Health Status Indicators by Texas Public Health Regions
Center for Health Statistics - 477
Electronic File
E4-20-4
Minority Health Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E56-11815
Assessment of Parasitic Disease in Children in Five Communities in the Border Region-Far West Texas
HSR 9/10 - 584
Electronic File
EF12-13204
Texas Refugee Health Assessment Form
Refugee Health - 815
Electronic File
TCADA-31
An Ethnographic Comparison of the Mexican American Drug Culture in El Paso, Texas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-32
An Ethnographic Study of Mexican American Inhalant Abusers in San Antonio, Texas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-38
An Ethnographic Study of Heroin Abuse by Mexican Americans in San Antonio, Texas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-40
Patterns of Volatile Substance Abuse Among the Kickapoo People in Eagle Pass, Texas
Mental Hlth/Sub Abuse 488
Electronic File
E10-71
Backbone: In Support of African American Women
Osteoporosis - 225
Electronic File
F12-13204
Texas Refugee Health Assessment Form
Refugee Health - 814
Forms
E05-03877
Chest Syndrome
Newborn Screening - 313
Electronic File
E13-13491
Black Women and HIV in the Golden Triangle
HIV/STD - 886
Electronic File
E05-03872
Sickle Beta+ Thalassemia
Newborn Screening - 313
Electronic File
E05-03873
Sickle Cell Anemia and Stroke
Newborn Screening - 313
Electronic File
E05-03874
Pain in the Child with Sickle Cell Disease
Newborn Screening - 313
Electronic File
E05-03875
Hemoglobin C Disease
Newborn Screening - 313
Electronic File
E05-03876
Pneumococcal Infection and Penicillin
Newborn Screening - 313
Electronic File
E10-70
Step By Step: Supporting Hispanic Women's Health at Every Stage of Life
Osteoporosis - 225
Electronic File
E05-03870
Hemoglobin Sickle C Disease
Newborn Screening - 313
Electronic File
E05-10378
Sickle Cell Disease and Sickle Cell Trait
Newborn Screening - 313
Electronic File
E10-72
The Secret of Maria's New Life
Osteoporosis - 225
Electronic File
E05-03878
Splenic Sequestration Crisis
Newborn Screening - 313
Electronic File
E05-03879
Priapism
Newborn Screening - 313
Electronic File
E05-10119
Sickle Cell Disease: A Resource For the Educator
Newborn Screening - 313
Electronic File
E05-10103
Hemoglobin E
Newborn Screening - 313
Electronic File
05-10779
Sickle Cell Disease Affects Us All - Where Are Your Roots? (Limit 5)
Newborn Screening - 136
Posters
E05-03945
Sickle Cell Anemia: A Parent's Guide For the School Age Child
Newborn Screening - 313
Electronic File
05-06442
A Sickle Cell Coloring Book (Limit 5)
Newborn Screening - 136
Coloring Books
E05-03880
Aplastic Crisis
Newborn Screening - 313
Electronic File
E05-10579
Sickle Cell Dis. in Children & Adolescents: Diagn., Gdlines for Comp. Care & Protocols for Mgt.
Newborn Screening - 313
Electronic File
E1-68
The Infant and Young Child with Sickle Cell Anemia: A Guide Especially for Parents
Newborn Screening - 313
Electronic File
E13-13504
Black Women and HIV in Texas
HIV/STD - 886
Electronic File
E13-13498
Black Women and HIV in TDCJ
HIV/STD - 886
Electronic File
E13-13497
Black Women and HIV in San Antonio
HIV/STD - 886
Electronic File
E13-13496
Black Women and HIV in Northeast Texas
HIV/STD - 886
Electronic File
E13-13495
Black Women and HIV in Houston
HIV/STD - 886
Electronic File
E13-13494
Black Women and HIV in Fort Worth
HIV/STD - 886
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 125 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
4-222
I Did It for My Sister (HIV poster for African American MSM) (limit 100)
Warehouse
Posters
E05-03871
Sickle Beta Zero Thalassemia
Newborn Screening - 313
Electronic File
4-224
HIV Can't Stop a Strong Black Woman (poster for African American women) (Limit 100)
Warehouse
Posters
E1-66
So Your Baby Has the Sickle Cell Trait
Newborn Screening - 313
Electronic File
E13-13359
African American Women and HIV in Texas
HIV/STD - 332
Electronic File
E13-13279
Hispanics in Texas: Late HIV Diagnosis and Out of Care
HIV/STD - 783
Electronic File
4-225
HIV is No Match for Strong Black Women (poster for African American Women) (Limit 100)
Warehouse
Posters
E10-76
Remember When Your Mother Used to Say "Just Drink This--It's Good For You?" (Asian women)
Osteoporosis - 225
Electronic File
E10-75
Congratulations, Your Life Is About to Change for the Better (African American women)
Osteoporosis - 225
Electronic File
E10-73
Wisdom: Sharing the Secrets of Long Life with Asian Women
Osteoporosis - 225
Electronic File
4-226
I Did it for My Man (HIV poster for African American MSM) (Limit 100)
Warehouse
Posters
CPW-02A
Case Management Migrant Information Form
Case Management - 309
Electronic File
E13-13493
Black Women and HIV in Dallas
HIV/STD - 886
Electronic File
Newsletters (DSHS) / Boletines informativos (DSHS) E16-11164
Texas Risk Factor Report
Behavioral Risk Factor Surveillance System - 223
Electronic Newsletter/Magazine
04-11373
Chronic Disease in Texas Newsletter
Tobacco Prevention - 272
Newsletters
05-10004
The CAHOOT Newsletter
Newborn Screening - 67
Newsletters
E50-10970
Zoonosis News from Health Service Region 1
HSR 1-Zoonosis - 604
Electronic Newsletter/Magazine
E04-11373
Chronic Disease in Texas Newsletter
Adult Health - 231
Electronic Newsletter/Magazine
E05-10004
The CAHOOT Newsletter
Newborn Screening - 282
Electronic Newsletter/Magazine
E05-10832
Texas PKU Connections
Newborn Screening - 281
Electronic Newsletter/Magazine
E05-10897
Newborn Screening News
Newborn Screening - 153
Electronic Newsletter/Magazine
E05-10958
Texas School Health Bulletin
School Health Program 637
Electronic Newsletter/Magazine
E06-10664
Texas WIC News
Nutrition Services - 444
Electronic Newsletter/Magazine
E09-11441
Texas Childhood Lead Poisoning Prevention Program Newsletter
Childhood Lead Poisoning - 385
Electronic Newsletter/Magazine
E11-10950
The Upshot
Immunization - 167
Electronic File
E18-10948
Asbestos Programs Branch Update (Asbestos newsletter)
Envir Hlth-PSQA - 606
Electronic Newsletter/Magazine
05-10832
Texas PKU Connections (Limit 5)
Newborn Screening - 67
Newsletters
E32-10915
Funding Alert (weekly announcements)
Funding Info Center - 152
Electronic File
E10-10542
Texas Cancer Reporting News
Cancer Epi/Surv - 111
Electronic Newsletter/Magazine
E04-10279
The Commitment
Breast & Cervical Cancer - 374
Electronic Newsletter/Magazine
E45-11004
Texas Diabetes Newsletter (also called The Cornerstone)
Texas Diabetes Council 768
Electronic Newsletter/Magazine
Stock #4-25-lang Revised 10/25/2010
Page 126 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E19-10515
DSHS Staff News (formerly Pulse Monitor)
Communications - 393
Electronic File
E50-11436
Preparedness Planning Review (Bioterrorism Planning Review Newsletter)
HSR 1 - Public Health Preparedness - 160
Electronic Newsletter/Magazine
E53-10879
Quarterly Zoo Crew Dispatch
HSR 6/5S-Zoonosis Control - 156
Electronic Newsletter/Magazine
E54-11999
Hot Shot News (newsletter)
HSR - Immunization - 469
Electronic Newsletter/Magazine
E54-12344
Health Central Newsletter
HSR 7- Public Health Promotion - 176
Electronic Newsletter/Magazine
E54-12596
Epidemiology and Surveillance Quarterly Newsletter
HSR 7- Epidemiology - 696 Electronic Newsletter/Magazine
E56-12176
Preparedness and Response Newsletter
HSR 9/10 - 593
Electronic Newsletter/Magazine
E57-10768
Region 11 Zoonosis Control Monthly Newsletter
Region 11 - Zoonosis Control - 547
Electronic Newsletter/Magazine
E58-10955
Texas Birth Defects Monitor: A Semiannual Data and Research Update
Birth Defects Epi - 169
Electronic Newsletter/Magazine
E59-12544
The EpiLink Online Bulletin
Infectious Disease - 725
Electronic Newsletter/Magazine
E75-10783
The Examiner
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic Newsletter/Magazine
E77-10805
Board Bulletin (Texas State Board of Social Worker Examiners)
Tx State Bd of Social Worker Examiners - 380
Electronic Newsletter/Magazine
TEX-EMS
Texas EMS Magazine
EMS - 532
Electronic Newsletter/Magazine
E42-10500
Texas Alzheimer's News
Adult Health - 231
Electronic Newsletter/Magazine
35-12604
The Vital Statistics Review
Vital Statistics - 756
Newsletters
05-10897
Newborn Screening News
Newborn Screening - 67
Newsletters
06-10664
Texas WIC News
10-10542
Texas Cancer Reporting News
Cancer Epi/Surv - 61
Newsletters
E35-12604
The Vital Statistics Review
Vital Statistics - 757
Electronic Newsletter/Magazine
18-10948
Asbestos Programs Branch Update (Asbestos newsletter)
Asbestos - 148
Newsletters
76-10794
St Bd Exam for Speech-Lang Pathology and Audiology Newsletter
State Bd of Examiners Speech & Audiology - 129
Newsletters
40-11084
TCID Round-up Newsletter
Texas Center for Infectious Disease - 200
Newsletters
42-10500
Texas Alzheimer's News
Adult Health - 173
Newsletters
45-11004
Texas Diabetes Newsletter
Texas Diabetes Council 305
Newsletters
50-11436
Preparedness Planning Review (Bioterrorism Planning Review Newsletter)
HSR 1 - Public Health Preparedness - 159
Newsletters
50-11807
Vaccine for Children Immunization Newsletter (Region 1)
HSR 1- Immunization - 330 Newsletters
53-10879
Quarterly Zoo Crew Dispatch
HSR 6/5S-Zoonosis Control - 143
Newsletters
54-11200
Zoonosis Connection
HSR 7 - Zoonosis Control Div. - 230
Newsletters
68-10725
Respiratory Care Practitioners Bulletin - A Newsletter for Resp Care Practitioners
Respiratory Care Pract. Certif. Program - 843
Newsletters
16-11164
Texas Risk Factor Report
Behavioral Risk Factor Surveillance System - 222
Newsletters
54-11999
Hot Shot News (newsletter)
HSR - Immunization - 468
Newsletters
Stock #4-25-lang Revised 10/25/2010
Newsletters
Page 127 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
75-10783
The Examiner
Tx St. Bd of Examiners of Prof Counselors - 128
Newsletters
73-10823
The Communicator
Professional Licensing and Certification - 98
Newsletters
72-04770
The Menu - Bulletin of the Texas Board of Examiners of Dietitians
Tx State Bd of Examiners of Dietitians - 127
Newsletters
71-10739
Texas Board of Orthotics and Prosthetics Bulletin
Tx Bd of Orthotics & Prosthetics - 130
Newsletters
62-10692
Tx Resource: the Official Newsletter of the Council on Sex Offender Treatment
Council on Sex Offender Treatment - 118
Newsletters
58-10955
Texas Birth Defects Monitor: A Semiannual Data and Research Update
Birth Defects Epi - 110
Newsletters
57-10768
Region 11 Zoonosis Control Monthly Newsletter
Region 11 - Zoonosis Control - 108
Newsletters
56-12399
Zoonosis News from Health Service Region 9/10
HSR 9/10 -Zoonosis- 618
Newsletters
Preparedness and Response Newsletter
HSR 9/10 - 524
Newsletters
56-12176
Nursing / Enfermeria E25-13171
2008 Update on Faculty Demographics in Vocational Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13118
2008 Update on Faculty Demographics in Professional Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13119
2008 Update on Professional Nursing Program Characteristics
TX Ctr Nursing Workforce - 673
Electronic File
E25-13434
A Guide for Data and Career Information on Registered Nurses
Hlth Prof Resource Ctr 662
Electronic File
E25-13149
2008 Update on Student Admission, Enrollment and Graduation Trends in Vocational Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13380
2009 Update on Student Demographics in Professional Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13383
2009 Update on Faculty Demographics in Vocational Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13379
2009 Update on Student Admission, Enrollment, and Graduation Trends in Professional Nursing Program
TX Ctr Nursing Workforce - 673
Electronic File
E25-13150
2008 Update on Graduate Demographics from Vocational Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13151
2008 Update on Vocational Nursing Program Characteristics
TX Ctr Nursing Workforce - 673
Electronic File
E25-13384
2009 Update on Vocational Nursing Student Demographics
TX Ctr Nursing Workforce - 673
Electronic File
E25-13116
2008 Update on Student Admission, Enrollment and Graduation Trends in Professional Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13054
Fact Sheet: 2008 Hospital Nurse Staffing Survey (HNSS) Vacancy and Turnover Rates
TX Ctr Nursing Workforce - 673
Electronic File
E25-13382
2009 Update on Vocational Nursing Program Characteristics
TX Ctr Nursing Workforce - 673
Electronic File
E25-13385
2009 Educational Pipelines for Nurses in Texas
TX Ctr Nursing Workforce - 673
Electronic File
E25-13053
Fact Sheet: 2008 Hospital Nurse Staffing Survey (HNSS) Expansion of Beds
TX Ctr Nursing Workforce - 673
Electronic File
E25-13050
Vocational Nursing (VN) Programs: 2007 Student Admission, Enrollment, Graduation, and Student Demogr
TX Ctr Nursing Workforce - 673
Electronic File
E25-13051
Vocational Nursing (VN) Programs: 2007 Faculty Demographics
TX Ctr Nursing Workforce - 673
Electronic File
E6-223
Pesticide Exposure Surveillance in Texas (brochure)
Pesticide Exposure Surv (PEST) - 452
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 128 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
EL-2
Nurses' Daily Report (no print copy available)
Public Health Nursing - 263 Electronic File
E4-20-12
Home Health Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E25-13381
2009 Update on Student Admission, Enrollment, and Graduation Trends in Vocational Nursing Program
TX Ctr Nursing Workforce - 673
Electronic File
E25-13052
Vocational Nursing (VN) Programs: 2007 Geographic Location, Length of Curriculum, and Resources Need
TX Ctr Nursing Workforce - 673
Electronic File
EPSDT-15
Case Management for Children and Pregnant Women (Case Management Poster) 8-1/2" x 11"
Texas Health Steps - 24
Electronic File
E25-13086
Texas Center for Nursing Workforce Studies: 2008 Report
TX Ctr Nursing Workforce - 673
Electronic File
E25-13063
2008 Hospital Nurse Staffing Survey Highlights of Findings and Recommendations
TX Ctr Nursing Workforce - 673
Electronic File
E25-13064
2008 Long Term Care Nurse Staffing Survey Highlights of Findings and Recommendations
TX Ctr Nursing Workforce - 673
Electronic File
EL-39
Statement of Services (no print copy available)
Public Health Nursing - 263 Electronic File
E25-13378
2009 Update on Professional Nursing Program Characteristics
TX Ctr Nursing Workforce - 673
Electronic File
E25-13377
2009 Update on Faculty Demographics in Professional Nursing Program
TX Ctr Nursing Workforce - 673
Electronic File
E25-13049
Turnover and Vacancy Rates in Texas Long Term Care Nursing Faciliites for Unlicensed Nursing Staff
TX Ctr Nursing Workforce - 673
Electronic File
E25-12513
Supply of and Demand for Registered Nurses and Nurse Graduates in Texas:Report to 80th Legislature
TX Ctr Nursing Workforce - 673
Electronic File
E25-13026
2007 Update on Professional Nursing Programs: Resources Needed to Increase Capacity, Geographic Loca
TX Ctr Nursing Workforce - 673
Electronic File
E08-0018
Oral Health School Nurse Manual (click on Education on web page)
Oral Health - 695
Electronic File
E25-10992
Selected Health Professions in Texas
Hlth Prof Resource Ctr 662
Electronic File
E25-13027
2007 Update on Faculty Demographics in Professional Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-11994
Demographics of the Nursing Workforce Texas - 2003
TX Ctr Nursing Workforce - 673
Electronic File
E25-12039
Texas Sources for Nursing Supply Data
Ctr for Health Statistics 181
Electronic File
E25-12040
Demographics and Trends in Nursing Education in Texas
TX Ctr Nursing Workforce - 673
Electronic File
E25-12041
Migration Trends: Texas RN and LVN Workforce
TX Ctr Nursing Workforce - 673
Electronic File
E25-12095
Reports on Nursing Workforce and Nursing Education (October, 2004)
Ctr for Health Statistics 181
Electronic File
E25-12096
Executive Summaries of Reports on Nursing Workforce and Nursing Education (October, 2004)
Ctr for Health Statistics 181
Electronic File
E25-12112
Texas Registered Nurse Hospital Staffing Survey
TX Ctr Nursing Workforce - 673
Electronic File
E25-12225
Increasing RN Graduates: Admission, Progression, and Graduation in Texas Schools of Nursing
TX Ctr Nursing Workforce - 673
Electronic File
E25-12505
Highlights: The Supply of Registered Nurses in Texas - 2005
TX Ctr Nursing Workforce - 673
Electronic File
E05-06836
Newborn Screening Program Practitioner's Guide
Newborn Screening - 68
Electronic File
E25-12519
Highlights: Recruitment and Retention of Nursing Faculty
TX Ctr Nursing Workforce - 673
Electronic File
E25-13025
2007 Update on Student Admission, Enrollment, and Graduation Trends in Professional Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-12841
Professional Nursing Education in Texas - Demographics & Trends: 2006 Executive Summary
TX Ctr Nursing Workforce - 673
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 129 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E25-12830
Professional Nursing Education in Texas-Demographics and Trends: 2006
TX Ctr Nursing Workforce - 673
Electronic File
E25-12529
Highlights: White Paper Briefs on Major Nursing Workforce Issues
TX Ctr Nursing Workforce - 673
Electronic File
E25-12528
Highlights: The Supply of and Demand for Registered Nurses and Nurse Graduates in Texas: Rpt to Leg
TX Ctr Nursing Workforce - 673
Electronic File
E25-12511
Texas Hospital Nurse Staffing Survey (2006)
TX Ctr Nursing Workforce - 673
Electronic File
E25-12520
Highlights: Admission, Enrollment and Graduation Trends in Initial RN Licensure Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-12512
Texas Hospital Nurse Staffing Survey (2006)-Executive Summary and Recommendation
TX Ctr Nursing Workforce - 673
Electronic File
E25-12518
Highlights: Recruitment and Retention of Nurses in the Workforce
TX Ctr Nursing Workforce - 673
Electronic File
E25-12517
Highlights: Strategies to Retain Older, Experienced Nurses in the Workforce
TX Ctr Nursing Workforce - 673
Electronic File
E25-12516
Highlights: Internationally Educated Nurses in Texas
TX Ctr Nursing Workforce - 673
Electronic File
E25-12515
Highlights: The Economic Impact of the Nursing Shortage
TX Ctr Nursing Workforce - 673
Electronic File
E25-12514
Supply of and Demand for Registered Nurses and Nurse Graduates in Texas: Executive Summary/Recommend
TX Ctr Nursing Workforce - 673
Electronic File
16-4
Know Your Rights #1 (available from DSHS warehouse only)
Warehouse
Posters
E25-12522
Highlights: Texas Hospital Nurse Staffing Survey (2006)
TX Ctr Nursing Workforce - 673
Electronic File
E25-13117
2008 Update on Student Demographics in Professional Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13048
Turnover and Vacancy Rates in Texas Long Term Care Nursing Faciliites for RNs and LVNs
TX Ctr Nursing Workforce - 673
Electronic File
E25-13044
2008 Hospital Nurse Staffing Survey (HNSS) Methods of Interim Staffing of Registered Nurses
TX Ctr Nursing Workforce - 673
Electronic File
E25-13043
Directors of Nursing (DON) in Texas Long Term Care Nursing Facilities
TX Ctr Nursing Workforce - 673
Electronic File
E25-13028
2007 Update on Student Demographics in Professional Nursing Programs
TX Ctr Nursing Workforce - 673
Electronic File
Nutrition / Nutricion E45-10960
Type 2 Diabetes in Children and Adolescents Statewide Action Plan
Texas Diabetes Council 425
Electronic File
F72-12124
Dietitian Renewal Form
Tx State Bd of Examiners of Dietitians - 127
Forms
F72-10745
Dietitian Application for Licensure
Tx State Bd of Examiners of Dietitians - 127
Forms
EGN-000-20
Let's get cooking with Vegetables
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EGN-000-19
Let's get cooking with Fruits
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EGN-000-11
Quick and Easy Vitamin A
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EGN-000-10
Food Demonstrations: Orange Froth and Frozen Chocolate Banana
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EGN-000-07
Small Changes, Big Difference
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EFG-000-04
5-a-day Bingo
Nutrition Services - 643
WIC Lesson/TrainingElectronic
06-10664
Texas WIC News
Stock #4-25-lang Revised 10/25/2010
Newsletters
Page 130 of 221
Stock Number
Title
E10-15C
ABCs of Health - Cholesterol
13-37-1
Infant Nutrition Module Answer Key (WIC)
Format
Source (must print Contact List to have all necessary information) Adult Health - 231
Electronic File WIC Lessons/Training
4-191
Before You Start Making Babies, Start Taking Multvitamins with Folic Acid
Warehouse
Posters
72-04770
The Menu - Bulletin of the Texas Board of Examiners of Dietitians
Tx State Bd of Examiners of Dietitians - 127
Newsletters
E06-10104
Iron Deficiency, No. 11
Nutrition Services - 199
Electronic File
E06-10106
Meat and Poultry Guidelines, No. 2
Nutrition Services - 199
Electronic File
EF72-12124
Dietitian Renewal Form
Tx State Bd of Examiners of Dietitians - 508
Electronic File
E06-11170
Farmers' Market Nutrition Program
Nutrition Services - 224
Electronic File
EF72-10745
Dietitian Application for Licensure
Tx State Bd of Examiners of Dietitians - 508
Electronic File
E108-12871
Farm to Work Toolkit
Nutrition/Physical Activity/Obesity Prevent 738
Electronic File
E13-06-10411
Folic Acid and Women of Childbearing Age, No. 17
Nutrition Services - 199
Electronic File
E13-06-11056
Texas Nutrition Risk Manual
Nutrition Services - 73
Electronic File
E13-33
Basic Nutrition Module
Nutrition Services - 205
Electronic File
E45-10778
Medical Nutrition Algorithm IFG/Type 2 Diabetes Prevention and Therapy
Texas Diabetes Council 197
Electronic File
E44-10946
Your Life is About to Change for the Better (general audiences)
Osteoporosis - 225
Electronic File
E06-10664
Texas WIC News
Nutrition Services - 444
Electronic Newsletter/Magazine
Occupational Health & Safety / Salud y seguridad ocupacional EF23-10857
Bloodborne Pathogen Control Program Device Registration Application
Drugs & Food Safety Licensing - 89
Electronic File
F59-10666
Contaminated Sharps Reporting Form
Infectious Disease - 35
Forms
F49-11634
Electronic Filing Cover Sheet for the Texas Tier Two Report
Policy, Standards, & Quality Assurance Unit 100
Forms
F49-11631
Open Records Request (HazCom Info)
Policy, Standards, & Quality Assurance Unit 100
Forms
F49-11630
Sample Training Roster (Model Employee Training Roster-Texas Hazard Communication Act)
Policy, Standards, & Quality Assurance Unit 100
Forms
F49-11629
Tier Two Paperwork Reduction Form (PRF)
Policy, Standards, & Quality Assurance Unit 100
Forms
EF59-10666
Contaminated Sharps Reporting Form
Infectious Disease - 185
Electronic File
EF49-11634
Electronic Filing Cover Sheet for the Texas Tier Two Report
Tier Two - 349
Electronic File
EF49-11632
Workplace Chemical List as required by Texas Hazard Communication Act
Envir Hlth-PSQA - 55
Electronic File
EF49-11631
Open Records Requests (HazCom Info)
Tier Two - 349
Electronic File
EF49-11630
Sample Training Roster (Model Employee Training Roster-Texas Hazard Communication Act)
Envir Hlth-PSQA - 55
Electronic File
EF27-10570
Project Safety Review Checklist
Risk Management/Safety Office - 259
Electronic File
E59-11368
Bloodborne Pathogen Control Rules, Forms, and Plans
Infectious Disease - 432
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 131 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E15-25
Hazard Report Form
Risk Management/Safety Office - 259
Electronic File
18-10638
Notice to Employees (Texas Hazard Communication Act)
Policy, Standards, & Quality Assurance Unit 100
Posters
203-1
Notice to Employees - Texas Regulations for Control of Radiation
Radiation Control - 326
Electronic File
232-1
Notice to Employees - Dentists only - Texas Regulations for Control of Radiation
Radiation Control - 326
Electronic File
49-11745
Hazardous Substances Act Registration Fact Sheet
Policy, Standards, & Quality Assurance Unit 100
Fact Sheets
EF49-11629
Tier Two Paperwork Reduction Form (PRF)
Tier Two - 349
Electronic File
E15-24
Safety Inspection Checklist
Risk Management/Safety Office - 259
Electronic File
E18-10638
Notice to Employees (Texas Hazard Communication Act)
Envir Hlth-PSQA - 55
Electronic File
E2-10
Texas Voluntary Indoor Air Quality Guidelines for Government Buildings
Indoor Air Quality - 8
Electronic File
E4-20-16
Occupational Health & Safety/Back Safety/Infection Control Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E4-20-8
Alzheimer's Disease, Aging, Long Term Care, Infection Control, Fire Safety, Back Safety
Audiovisual Library - 196
Electronic File
E49-11745
Hazardous Substances Act Registration Fact Sheet
Consumer Prod Safety 423
Electronic File
E1-501
Infection Control Manual for Ambulatory Care Clinics
Public Health Nursing - 263 Electronic File
Organ Donation / Donante de un organo (transplante de organo) 14-15
Donate Life Texas (African American Poster) (limit 20)
Warehouse
Posters
E07-12809
Glenda Dawson Donate Life - Texas Registry Donor Card
Donate Life Texas Registry - 873
Electronic File
14-17
Donate Life Texas (paycheck stuffer)
Warehouse
Stuffers
Orthotics/Prosthetics / Ortopedicos / Prosteticos F71-10740
Texas Board of Orthotics and Prosthetics - Facility Accreditation Application Packet
Tx Bd of Orthotics & Prosthetics - 130
Forms
71-10739
Texas Board of Orthotics and Prosthetics Bulletin
Tx Bd of Orthotics & Prosthetics - 130
Newsletters
E71-11197
Orthotists and Prosthetists Occupations Code
Texas Board of Orthotics and Prosthetics - 239
Electronic File
E71-11198
Orthotics and Prosthetics Board Rules
Texas Bd. Of Orthotics & Prosthetics - 241
Electronic File
EF76-11177
Continuing Education-College University Course Work Form
State Bd of Examiners for Speech & Audiology -240
Electronic File
F71-10741
Texas Board of Orthotics and Prosthetics - Licensure Application Packet
Tx Bd of Orthotics & Prosthetics - 130
Forms
E71-11067
Acquiring Licensure as a Uniquely Qualified Person
Texas Board of Orthotics and Prosthetics - 239
Electronic File
Osteoporosis / Osteoporosis E10-70
Step By Step: Supporting Hispanic Women's Health at Every Stage of Life
Osteoporosis - 225
Electronic File
E10-72
The Secret of Maria's New Life
Osteoporosis - 225
Electronic File
E10-73
Wisdom: Sharing the Secrets of Long Life with Asian Women
Osteoporosis - 225
Electronic File
E10-74
Life Lessons: Smart Thinking for Today's Women
Osteoporosis - 225
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 132 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E10-75
Congratulations, Your Life Is About to Change for the Better (African American women)
Osteoporosis - 225
Electronic File
E10-77
Nobody Said You Had to Act Your Age
Osteoporosis - 225
Electronic File
E44-10831
1998-99 Biennial Report of the Osteoporosis Advisory Committee
Osteoporosis - 225
Electronic File
E44-10937
Osteoporosis Resource Guide
Osteoporosis - 225
Electronic File
E10-71
Backbone: In Support of African American Women
Osteoporosis - 225
Electronic File
Remember When Your Mother Used to Say "Just Drink This--It's Good For You?" (Asian women)
Osteoporosis - 225
Electronic File
Scabies Fact Sheet
HIV/STD - 449
Fact Sheets
E7-27
Zoonoses
Zoonosis - 376
Electronic File
E7-34
Toxoplasmosis
Zoonosis - 376
Electronic File
E10-76
Parasites / Parasitos E13-11910
Parenting / Crianza de los ninos E59-11511
A Guide for Parents - Get Smart about Antibiotics
Infectious Disease - 602
Electronic File
E1-316
Information for Parents of Newborns (required in SB 316)
Perinatal/Maternal/Child 539
Electronic File
E13-53
Just for Dad
Nutrition Services - 809
Electronic File
E06-10256
Reading to Children, No. 13
Nutrition Services - 199
Electronic File
Patient/Client Records / Archivos de pacientes/clientes TB-622
Treatment Record
Infectious Disease Control Unit - TB - 253
Forms
TB-621
Preventive Treatment Record
Infectious Disease Control Unit - TB - 253
Forms
WHR-7
Maternity Clinic Appointment Card
Warehouse
Forms
ECORE-1
Client/Household Information (no print copy available)
Public Health Nursing - 263 Electronic File
ECH-1
Child Health History
Texas Health Steps - 284
ECORE-7
Progress Notes (no print copy available)
Public Health Nursing - 263 Electronic File
ECH-14
Dietary Recall and Assessment for Children 5 to 9, 24 Hours
Health Promotion - 642
Electronic File
ECH-15
Dietary Recall and Assessment for Children 10 to 20, 24 Hours
Health Promotion - 642
Electronic File
ECH-22
Child Health Record, Medical Checkup Flowsheet
Texas Health Steps - 284
Electronic File
ECH-4
Child Health Record, 7 - 12 Months
Texas Health Steps - 284
Electronic File
ECH-5
Child Health Record, 13 Months - 2 Years
Texas Health Steps - 284
Electronic File
E13-06-11656
Dietary Recall and Assessment for Children 1 to 4, 24 Hours
Nutrition Services - 359
Electronic File
ECH-7
Child Health Record, 6 - 10 Years
Texas Health Steps - 284
Electronic File
ECH-2
Child Health Record, Birth -1 Month
Texas Health Steps - 284
Electronic File
ECORE-10
Health Record Instructions (no print copy available)
Public Health Nursing - 263 Electronic File
ECORE-1A
Client/Household Information Update
Public Health Nursing - 263 Electronic File
ECORE-2
Physical Exam (no print copy available)
Public Health Nursing - 263 Electronic File
ECORE-3
Referral List/Long Term Problem List (no print copy available)
Public Health Nursing - 263 Electronic File
ECORE-4
Medical/Social History (no print copy available)
Public Health Nursing - 263 Electronic File
ECORE-4A
Diet History (no print copy available)
Public Health Nursing - 263 Electronic File
ECORE-6
Medication Issued/Medication Orders (no print copy available)
Public Health Nursing - 263 Electronic File
ECORE-5
Flow Sheet Immunizations (no print copy available)
Public Health Nursing - 263 Electronic File
Stock #4-25-lang Revised 10/25/2010
Electronic File
Page 133 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
ECH-6
Child Health Record, 3 - 5 Years
Texas Health Steps - 284
Electronic File
EWHR-2
Routine Supply Visit
Perinatal/Maternal/Child 446
Electronic File
EWHR-IN
Women's Health Record Instructions
Perinatal/Maternal/Child 446
Electronic File
ECH-3
Child Health Record, 2 - 6 Months
Texas Health Steps - 284
Electronic File
EWHR-3
Obstetric Flow Record
Perinatal/Maternal/Child 446
Electronic File
CH-7
Child Health Record, 6 - 10 Years
Texas Health Steps - 314
Forms
EWHR-1
Education/Counseling Record
Perinatal/Maternal/Child 446
Electronic File
EL-29
Referral Form (no print copy available)
Public Health Nursing - 263 Electronic File
EF12-12168
Monthly Tuberculin Skin Testing Form
Infectious Disease Control Unit - TB - 320
Electronic File
EF05-11573
Adolescent Health Exam Packet & Preventative Services Checklist (11-21 years)
Adolescent Health - 338
Electronic File
ECORE-9
Client Follow-Up Health Record
Public Health Nursing - 263 Electronic File
CH-2
Child Health Record, Birth -1 Month
Texas Health Steps - 314
ECORE-8
Triage Note
Public Health Nursing - 263 Electronic File
CH-3
Child Health Record, 2 - 6 Months
Texas Health Steps - 314
Forms
CH-4
Child Health Record, 7 - 12 Months
Texas Health Steps - 314
Forms
CH-5
Child Health Record, 13 Months - 2 Years
Texas Health Steps - 314
Forms
CH-6
Child Health Record, 3 - 5 Years
Texas Health Steps - 314
Forms
CH-1
Child Health History
Texas Health Steps - 314
Forms
EWHR-6
Provider Signature Sheet
Perinatal/Maternal/Child 446
Electronic File
Forms
Pediatric Medical Care / Atencion pediatrica EPB-109
Physician Reference on Follow-up Testing and Case Management
Childhood Lead Poisoning - 385
Electronic File
EM-76
Report of Otological Examination
Audiology - 440
Electronic File
EPB-104
Physician Checklist for Parent Education Topics
Childhood Lead Poisoning - 385
Electronic File
PB-104
Physician Checklist for Parent Education Topics
Warehouse
Forms
Psychotropic
Psychotropic Medication Utilization Parameters for Foster Children (only web version is available)
Medical Director/Behavioral Health - 520
Electronic File
E05-12258
1-3-6 Month Practioner's Guide
PACT-Health Steps - 554
Electronic File
E6-251
Standards for Child and Adolescent Immunization Practices
Immunization - 781
Electronic File
05-12258
1-3-6 Month Practioner's Guide
PACT-Health Steps - 782
Electronic File
EF05-11573
Adolescent Health Exam Packet & Preventative Services Checklist (11-21 years)
Adolescent Health - 338
Electronic File
6-30
Recommendations for the Prevention and Control of Communicable Disease in a Group-care (Limit 300)
Warehouse
Posters
E07-12153
What is a Medical Home? (Medical Home Brochure)
Children w/Special Health Care Needs - 512
Electronic File
Phenylketonuria (PKU) / Fenilcetonuria (PKU) E05-10581
The Young Woman with PKU
Newborn Screening - 313
Electronic File
E05-12102
Making Up Your Mind About PKU and Pregnancy (for young women with PKU ages 16-22 years old)
Newborn Screening - 281
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 134 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E05-12101
Let's Focus on PKU and Pregnancy (for adolescents with PKU ages 11-15 years old)
Newborn Screening - 281
Electronic File
E05-11162
The Child With PKU
Newborn Screening - 313
Electronic File
E05-10897
Newborn Screening News
Newborn Screening - 153
Electronic Newsletter/Magazine
E05-10832
Texas PKU Connections
Newborn Screening - 281
Electronic Newsletter/Magazine
E05-10582
The Young Woman with Mild Hyperphenylalanemia
Newborn Screening - 281
Electronic File
E05-10580
Schedule of Assessment for PKU
Newborn Screening - 281
Electronic File
E05-10450
A Teacher's Guide to PKU
Newborn Screening - 281
Electronic File
05-10897
Newborn Screening News
Newborn Screening - 67
Newsletters
05-10832
Texas PKU Connections (Limit 5)
Newborn Screening - 67
Newsletters
E05-10632
The Child with Mild Hyperphenylalanemia
Newborn Screening - 281
Electronic File
Physical Fitness / Estado fisico E108-12950
Updates for the Strategic Plan for the Prevention of Obesity in Texas
Nutrition/Physical Activity/Obesity Prevent 771
Electronic File
E108-12871
Farm to Work Toolkit
Nutrition/Physical Activity/Obesity Prevent 738
Electronic File
E45-11266
Exercise Algorithm - IFG/Type 2 Diabetes Prevention and Therapy
Texas Diabetes Council 197
Electronic File
13-06-12365-2
Child's Play Bulletin Board Exercise Helps Children To:
obes-portfolio
Texas Obesity Policy Portfolio
Bulletin Board Prog Coord, Policy & Innov- 785
Electronic File
Newborn Screening - 313
Electronic File
Physiology and Biology / Fisiologia y Biologia E05-03878
Splenic Sequestration Crisis
Poisons & Poisoning / Venenos e Intoxicaciones 6-82P
Texas Poison Center Network and Terrorism (poster)
Warehouse
Posters
E6-302
Mikey Learns About Poison Safety Coloring Book (order from 1-800222-1222)
Environ Epidemiology & Toxicology - 764
Coloring Books
E6-223
Pesticide Exposure Surveillance in Texas (brochure)
Pesticide Exposure Surv (PEST) - 452
Electronic File
E19-13243
What you need to know about Carbon Monoxide and Generators
Communications - 826
Electronic File
E1-26
What Parents Need to Know About Lead Poisoning
Childhood Lead Poisoning - 386
Electronic File
E09-13360
Evaluating Chromium Exposure: Information for Healthcare Providers
Hlth Assessment/Toxicology 754
Electronic File
E09-12821
Pesticides in Your Path
Pesticide Exposure Surv (PEST) - 452
Electronic File
E09-11840
Poison Prevention Activity Book (also order from 1-800-222-1222)
Environ Epidemiology & Toxicology - 311
Electronic File
E06-10213
Lead Poisoning, No. 10
Nutrition Services - 199
Electronic File
6-330
Poison CBRN Magnet
Warehouse
Magnets
6-322
Poison Control Magnets (also order from 1-800-222-1222)
Warehouse
Magnets
6-308
Poison Control 800# Poster
Warehouse
Posters
6-304
Poison Control Phone Sticker (also order from 1-800-222-1222)
Warehouse
Stickers
Stock #4-25-lang Revised 10/25/2010
Page 135 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
6-300
Poison Prevention Activity Book (must order from 1-800-222-1222)
Environ Epidemiology & Toxicology - 764
Coloring Books
6-302
Mikey Learns About Poison Safety Coloring Book (must order from 1-800-222-1222)
Environ Epidemiology & Toxicology - 764
Coloring Books
EF09-11927
Human Pesticide Exposure Report Form
Pesticide Exposure Surv (PEST) - 452
Electronic File
F09-11927
Human Pesticide Exposure Report Form
Pesticide Exposure Surv (PEST)- 702
Forms
E09-11441
Texas Childhood Lead Poisoning Prevention Program Newsletter
Childhood Lead Poisoning - 385
Electronic Newsletter/Magazine
Pollution / Contaminacion E2-10
Texas Voluntary Indoor Air Quality Guidelines for Government Buildings
Indoor Air Quality - 8
Electronic File
E09-11643
Texas Hazardous Substances Emergency Events Surveillance (HSEES) 1993-2000 Rpt on Trucking Services
Environ Epidemiology & Toxicology - 357
Electronic File
E09-11644
Texas Hazardous Substances Emergency Events Surveillance (HSEES) System Dec 2001 Security Survey of
Environ Epidemiology & Toxicology - 357
Electronic File
E09-12821
Pesticides in Your Path
Pesticide Exposure Surv (PEST) - 452
Electronic File
Prenatal & Postpartum Care / Cuidado prenatal y posparto E58-10957M
Birth Defect Risk Factor Series: Anal Atresia
Birth Defects Epi - 324
Electronic File
E58-10957L
Birth Defect Risk Factor Series: Trisomy 18
Birth Defects Epi - 324
Electronic File
E58-10957K
Birth Defect Risk Factor Series: Trisomy 13
Birth Defects Epi - 324
Electronic File
E58-10957J
Birth Defect Risk Factor Series: Oral Clefts
Birth Defects Epi - 324
Electronic File
E58-10957I
Birth Defect Risk Factor Series: Omphalocele
Birth Defects Epi - 324
Electronic File
E58-10957H
Birth Defect Risk Factor Series: NTDs
Birth Defects Epi - 324
Electronic File
E58-10957G
Birth Defect Risk Factor Series: Hydrocephaly
Birth Defects Epi - 324
Electronic File
E58-10957F
Birth Defect Risk Factor Series: Holoprosenchephaly
Birth Defects Epi - 324
Electronic File
E58-10957E
Birth Defect Risk Factor Series: Gastroschisis
Birth Defects Epi - 324
Electronic File
E13-101
Family Planning and Breastfeeding
Nutrition Services - 809
Electronic File
E58-10957D
Birth Defect Risk Factor Series: Down Syndrome
Birth Defects Epi - 324
Electronic File
E58-10957B
Birth Defect Risk Factor Series: Craniosynostosis
Birth Defects Epi - 324
Electronic File
E13-13263
HIV, Syphilis and Hepatitis B Testing for Pregnant Women
HIV/STD - 783
Electronic File
TCADA-43
Texas Survey of Postpartum Women and Drug-Exposed Infants
Mental Hlth/Sub Abuse 488
Electronic File
E1-316
Information for Parents of Newborns (required in SB 316)
Perinatal/Maternal/Child 539
Electronic File
EWHR-4
Pregnancy Test
Perinatal/Maternal/Child 446
Electronic File
E58-10955
Texas Birth Defects Monitor: A Semiannual Data and Research Update
Birth Defects Epi - 169
Electronic Newsletter/Magazine
F66-10717
Midwife Informed Choice and Disclosure Statement
Midwifery Program - 124
Forms
E58-10827
Birth Defects Glossary
Birth Defects Epi - 169
Electronic File
F66-10718
Midwife Training Certification Form - Newborn Screening Specimen Collection
Midwifery Program - 124
Forms
E4-206
10 Questions About Pregnancy and HIV
HIV/STD - 332
Electronic File
E35-10559
Texas Vital Statistics Annual Report
Center for Health Statistics - 107
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 136 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F66-10719
Newborn Screening Agreement for Newborn Babies of Midwife Clients
Midwifery Program - 124
Forms
E25-10956
Migration for Birth
Center for Health Statistics - 188
Electronic File
E58-10957C
Birth Defect Risk Factor Series: Diaphragmatic Hernia
Birth Defects Epi - 324
Electronic File
E6-54
Drinking When Pregnant Could Result in Fetal Alcohol Syndrome
Birth Defects Epi - 550
Electronic File
E6-34
Pregnancy, Hepatitis B and Rubella Facts (If you are pregnant..)
Immunization - 151
Electronic File
E58-11040
Birth Defects Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E58-10957W
Birth Defect Risk Factor Series: 47,XYY
Birth Defects Epi - 324
Electronic File
E66-10555
Texas Midwifery Board Midwifery Rules
Midwifery Program - 671
Electronic File
E66-10720
The Texas Midwifery Basic Information and Instructor Manual
Midwifery Program - 671
Electronic File
E6-73
Information on Umbilical Cord Blood Banking and Donation (HB 709)
Perinatal/Maternal/Child 735
Electronic File
E7-34
Toxoplasmosis
Zoonosis - 376
Electronic File
EBVS013
Vital Statistics Annual Report 1998
Center for Health Statistics - 107
Electronic File
EF66-10717
Midwife Informed Choice and Disclosure Statement
Midwifery Program - 671
Electronic File
E-Lister
What you should know about: Listeriosis (& listeriosis infection during pregnancy)
Infectious Disease - 183
Electronic File
E58-10957O
Birth Defect Risk Factor Series: Conotruncal Heart Defect
Birth Defects Epi - 324
Electronic File
E58-10957U
Birth Defect Risk Factor Series: Turner Syndrome
Birth Defects Epi - 324
Electronic File
E58-10957N
Birth Defect Risk Factor Series: Atrial Septal Defect
Birth Defects Epi - 324
Electronic File
E58-10957T
Birth Defect Risk Factor Series: Triploidy
Birth Defects Epi - 324
Electronic File
E58-10957S
Birth Defect Risk Factor Series: Renal Agenesis
Birth Defects Epi - 324
Electronic File
E58-10957R
Birth Defect Risk Factor Series: Pyloric Stenosis
Birth Defects Epi - 324
Electronic File
E58-10957Q
Birth Defect Risk Factor Series: Intestinal Atresia/Stenosis
Birth Defects Epi - 324
Electronic File
E58-10957P
Birth Defect Risk Factor Series: Ear Defects
Birth Defects Epi - 324
Electronic File
EPSDT-15
Case Management for Children and Pregnant Women (Case Management Poster) 8-1/2" x 11"
Texas Health Steps - 24
Electronic File
EWHR-1
Education/Counseling Record
Perinatal/Maternal/Child 446
Electronic File
EWHR-3
Obstetric Flow Record
Perinatal/Maternal/Child 446
Electronic File
F66-10716
Midwife Documentation Application
Midwifery Program - 124
Forms
F66-10715
Midwife - Newborn Screening Test Objection Form
Midwifery Program - 124
Forms
E1-120
Monthly Prenatal Fact Sheets
Perinatal/Maternal/Child 446
Electronic File
E58-10957V
Birth Defect Risk Factor Series: 47,XXX
Birth Defects Epi - 324
Electronic File
E06-10664
Texas WIC News
Nutrition Services - 444
Electronic Newsletter/Magazine
06-10664
Texas WIC News
4-191
Before You Start Making Babies, Start Taking Multvitamins with Folic Acid
Warehouse
Posters
58-10955
Texas Birth Defects Monitor: A Semiannual Data and Research Update
Birth Defects Epi - 110
Newsletters
E05-10370
Some Important Points to Remember About Prenatal Testing
Genetics Services - 69
Electronic File
E05-10372
Amniocentesis: For Prenatal Diagnosis
Genetics Services - 69
Electronic File
E06-10110
Maternal Nutrition: Gestational Weight Gain, No. 6
Nutrition Services - 199
Electronic File
Stock #4-25-lang Revised 10/25/2010
Newsletters
Page 137 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E06-10112
Postpartum Issues and Counseling Tips, No. 8
Nutrition Services - 199
Electronic File
WHR-7
Maternity Clinic Appointment Card
Warehouse
Forms
13-25
Girl Crib Card
Nutrition Services - 885
Small card
E06-10252
Gestational Diabetes, No. 12
Nutrition Services - 199
Electronic File
Privacy (including HIPAA) / Privacidad (incluyendo HIPAA) MH-8
Mental Health Privacy Notice
Prog Coord, Policy, Innov - 364
Electronic File
EISP-01
Health Insurance Portability and Accountability (HIPAA) Privacy Notice
Prog Coord, Policy, Innov - 364
Electronic File
Rabies and Animal Control / Rabia y control de animales 54-11200
Zoonosis Connection
HSR 7 - Zoonosis Control Div. - 230
Newsletters
E7-14
Facts about Rabies
Zoonosis - 376
Electronic File
E7-15
Rabies-and How It Can Be Controlled
Zoonosis - 376
Electronic File
E7-11
Oral Rabies Vaccination Program
Zoonosis - 376
Electronic File
E6-108
Rabies Prevention in Texas
Zoonosis - 376
Electronic File
E57-10768
Region 11 Zoonosis Control Monthly Newsletter
Region 11 - Zoonosis Control - 547
Electronic Newsletter/Magazine
E7-12
Organizing a Low-Cost Rabies Vaccination Clinic Pamphlet
Zoonosis - 376
Electronic File
E50-10970
Zoonosis News from Health Service Region 1
HSR 1-Zoonosis - 604
Electronic Newsletter/Magazine
E2-8
Bats
Zoonosis - 538
Electronic File
7-39
Bats and Rabies Poster for Schools
Warehouse
Posters
7-26
Rabies Poster (Protect Your Pets and Yourself Against Rabies! Vaccinate Your Pets)
Warehouse
Posters
7-21
Preventing Dog Bites to Infants
Warehouse
Posters
53-10880
How to Obtain Human Rabies Biologicals (Vaccine) from DSHS PHR 6/5S
HSR 6/5S-Zoonosis Control - 143
Forms
57-10768
Region 11 Zoonosis Control Monthly Newsletter
Region 11 - Zoonosis Control - 108
Newsletters
E7-16
The Wild Side of Rabies
Zoonosis - 376
Electronic File
7-25
Rabies and Wildlife (poster)
Warehouse
Posters
E7-20
Animal Bites
Zoonosis - 376
Electronic File
EC-99
Rabies-What You Need to Know (VIS)
Immunization - 781
Electronic File
E7-39
Bats and Rabies Poster for Schools
Zoonosis - 376
Electronic File
G-9
Rabies Submission Form (Laboratory Test for Rabies)
Labs - 30
Forms
Z-3
Registration Inspection - Rabies Quarantine Facility/Animal Shelter Facility
Warehouse
Forms
E7-25
Rabies and Wildlife (poster)
Zoonosis - 376
Electronic File
EG-9
Rabies Submission Form (Laboratory Test for Rabies)
Labs - 578
Electronic File
E7-22
Wildlife as Pets
Zoonosis - 376
Electronic File
E7-19
Rules of the Board of Health (Chapter 826-Rabies Control and Eradication)
Zoonosis - 105
Electronic File
E7-27
Zoonoses
Zoonosis - 376
Electronic File
E7-18
Rabies Control Act (Chapter 826 Texas Health & Safety Code)
Zoonosis - 105
Electronic File
E7-28
Caring for Your Pet
Zoonosis - 376
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 138 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Radiology / Radiologia CI-38
Confirmation of Scheduled Inspection with Special Instructions and Checklist
Radiation Control - 326
Electronic File
E22-10861
Incident Summary
Radiation Control - 177
Electronic File
E22-11395
Final Report of the Texas Indoor Radon Survey
Radiation Control - 464
Electronic File
E25TAC601.5(1)
Disclosure and Consent for Radiation Therapy
Health Facility Licensing 635
Electronic File
F65-10710
Medical Radiologic Technologist Certification Application
Medical Radiologic Technologist Certif Prog 123
Forms
F65-10711
Medical Radiologic Technologist Certification - Appl for Hardship Exemption
Medical Radiologic Technologist Certif Prog 123
Forms
IR-CROSS
Industrial Radiography Records Cross Check
Radiation Control - 326
Electronic File
LRS-17
Termination of a Registraton or Certification (Regulatory ServicesRadiation)
Radiation Control - 326
Electronic File
LRS-35
Additional Information for Accelerator Registration, Includes Shielding Form
Radiation Control - 326
Electronic File
BRC252-3
Notice of Intent to Work in Texas Under Reciprocity
Radiation Control - 326
Forms
EF65-10711
Application for Hardship Exemption - Medical Radiologic Technologist
Medical Radiologic Techn. Certif Prog - 842
Electronic File
LRS-18R
Radiation Machine Transfer/Disposal Form
Radiation Control - 326
Electronic File
226-1
Franchise Tax Information Form (Regulatory Services- Radiation)
Radiation Control - 326
Electronic File
BRC251-2
Application for a General License Acknowledgement of Devices Containing Radioactive Material
Radiation Control - 326
Forms
203-1
Notice to Employees - Texas Regulations for Control of Radiation
Radiation Control - 326
Electronic File
226-2
Registration Application for Users of Radiation Machines in Healing Arts, Veterinary Med, & Academic
Radiation Control - 326
Electronic File
226-3
Application for Registration of Industrial Radiation Machines and Services
Radiation Control - 326
Electronic File
226-7
Healing Arts Screening (Excerpt from 25 Texas Administrative Code Section 289.226(w)(4)
Radiation Control - 326
Electronic File
232-1
Notice to Employees - Dentists only - Texas Regulations for Control of Radiation
Radiation Control - 326
Electronic File
252-1
Business Information Form (Regulatory Services- Radiation)
Radiation Control - 326
Electronic File
252-2
Application for Radioactive Material License
Radiation Control - 326
Electronic File
252-2a
Application for Radioactive Material License (Medical Uses)
Radiation Control - 326
Electronic File
252-2b
Preceptor Statement for License Application
Radiation Control - 326
Forms
301-2
Application for Registration of Lasers and Laser Services
Radiation Control - 326
Electronic File
BRC251-1
Application for a General License Acknowledgement for in vitro Clinical or Lab Testing
Radiation Control - 326
Electronic File
42-3
Radiation Safety Officer - RSO Information for Registration
Radiation Control - 326
Electronic File
BRC230A&C
Application for Mammography Accreditation and Certification
Radiation Control - 21
Forms
BRC230ACF-2
Checklist for Interpreting Physicians
Radiation Control - 21
Forms
301-3
Written Notice for Laser Light Show in Texas
Radiation Control - 326
Electronic File
BRC230ACF-3
Checklist for Radiologic Technologist
Radiation Control - 21
Forms
BRC230ACF-4
Checklist for Medical Physicists
Radiation Control - 21
Forms
BRC230C-1
Application for Mammography Certification
Radiation Control - 21
Forms
BRC230C-2
Application for Adding Equipment to Mammography Certification
Radiation Control - 21
Forms
Stock #4-25-lang Revised 10/25/2010
Page 139 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Rodent Control / Control de roedores E7-36
Facts About Plague
Zoonosis - 376
Electronic File
E7-32
Murine Typhus (Fleaborne typhus)
Zoonosis - 376
Electronic File
E7-37
Hantavirus Pulmonary Syndrome
Zoonosis - 376
Electronic File
Sanitation / Sanidad E82-11183
Registered Sanitarian Advisory Committee Rules
Registered Sanitarian - 242
Electronic File
E49-11733
Suppliers for Germicides and Law Labels
Prod Safety - 396
Electronic File
E82-11437
Information on Continuing Education for Professional Sanitarians in Texas
Registered Sanitarian - 242
Electronic File
EF82-11947
Commercial Education Business Continuing Education Provider Application/Agreement (Prof Sanitarian)
Registered Sanitarian - 242
Electronic File
EF23-10857
Bloodborne Pathogen Control Program Device Registration Application
Drugs & Food Safety Licensing - 89
Electronic File
E49-12372
Renovator Label
Prod Safety - 396
Electronic File
E49-12370
Germicidal Treatment (GT) Log Book
Prod Safety - 396
Electronic File
E49-11739
Label for Items Made of All New Material
Prod Safety - 396
Electronic File
E49-11736
Processed Filled Material Label
Prod Safety - 396
Electronic File
F82-11947
Commercial Education Business Continuing Education Provider Application/Agreement (Prof Sanitarian)
Registered Sanitarian - 36
Forms
E23-13414
Three Compartment Sink
Food Establishment - 748
Electronic File
E19-13242
What you need to know about Vibrio
Communications - 827
Electronic File
E1-501
Infection Control Manual for Ambulatory Care Clinics
Public Health Nursing - 263 Electronic File
E49-11738
Germicidal Treatment Label
Prod Safety - 396
Electronic File
School Health / Salud escolar E05-10958
Texas School Health Bulletin
School Health Program 637
Electronic Newsletter/Magazine
ECD-0016
Texas Guide to School Health Programs
School Health Program 519
Electronic File
E05-12431
School Health Advisory Councils - A Guide for Texas School Districts
School Health Program 637
Electronic File
E05-12889
Coordinated School Health Program-Guide for Texas School Districts
School Health Program 743
Electronic File
Sex Education / Educacion sexual STDs and Condoms Fact Sheet
HIV/STD - 449
Electronic File
E13-11907
Oral Sex and HIV Fact Sheet
HIV/STD - 449
Fact Sheets
E13-11904
How to Talk to Your Kids about Sex Fact Sheet
HIV/STD - 449
Fact Sheets
E13-10959
1998 Behavioral Risk Factor Surveillance System HIV/AIDS Section and Sexual Behavior Module
HIV/STD - 447
Electronic File
12-0214
Sex Can Wait, Talking Can't
Abstinence Education - 790 DVD
E13-11890
Sexual Abuse / Abuso sexual F62-10689
Reg Sex Offender Treatment Prov/Affiliate Sex Offender Treatment Prov Appl
Council on Sex Offender Treatment - 118
Forms
62-10692
Tx Resource: the Official Newsletter of the Council on Sex Offender Treatment
Council on Sex Offender Treatment - 118
Newsletters
Stock #4-25-lang Revised 10/25/2010
Page 140 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Sexually Transmitted Diseases / Enfermedades de transmision sexual TCADA-35
Crack Cocaine as a Major Risk of HIV Transmission in a Crack House Population
Mental Hlth/Sub Abuse 488
Electronic File
E13-13206
Treatment Fact Sheet for Sex Partners of People with Chlamydia
TB/HIV/STD - 816
Electronic File
E13-11720
Texas HIV/STD E-Update
HIV/STD - 377
Electronic File
E13-13207
Treatment Fact Sheet for Sex Partners of People with Gonorrhea
TB/HIV/STD - 816
Electronic File
E59-11364
Notifiable Conditions in Texas
Infectious Disease - 112
Electronic File
E6-135
What You Should Know about Trichomonas (fact sheet)
HIV/STD - 332
Electronic File
E13-10667
Texas HIV/STD Annual Report
HIV/STD - 447
Electronic File
STD-27
Confidential Report of STD
Warehouse
Forms
CDC7354D
CDC73.54D Visual Case Analysis Sheet
Warehouse
Forms
STD-1
STD Envelope Label
Warehouse
Forms
CDC7354B
CDC73.54B Re-Interview Record
Warehouse
Forms
E13-11891
Gonorrhea Fact Sheet
HIV/STD - 449
Electronic File
E6-136
What You Should Know About Syphilis
HIV/STD - 332
Electronic File
E13-13262
Shortage of Erythromycin Ophtalimc Ointment for Neonatal Prophylaxix of Chlamydia and Gonorrhea
HIV/STD - 783
Electronic File
J-41
Lot Folder Status Sheet
Warehouse
Forms
F51-12002
Report of Sexually Transmitted Diseases (STD-27) Form - Region 2/3
HSR 2/3 - 161
Forms
E13-11906
NGU (Non-Gonococcal Urethritis) Fact Sheet
HIV/STD - 449
Fact Sheets
E6-110
Sexually Transmitted Disease Guidelines (2006 CDC)
HIV/STD - 288
Electronic File
E13-11905
Pubic Lice Fact Sheet
HIV/STD - 449
Fact Sheets
E6-123
What You Should Know About PID (Pelvic Inflammatory Disease)
HIV/STD - 332
Electronic File
13-12832
Texas Medical Monitoring Project Newsletter
HIV/STD Epidemiology 731
Newsletters
E13-11909
Pelvic Inflammatory Disease (PID) Fact Sheet
HIV/STD - 449
Fact Sheets
CDC7354C
CDC73.54C Cluster Interview Record
Warehouse
Forms
E13-11910
Scabies Fact Sheet
HIV/STD - 449
Fact Sheets
STD-28
Notification of Lab Test Findings
HIV/STD - 44
Forms
E13-11913
Summary of 2002 Sexually Transmitted Diseases (STD) Treatment Guidelines
HIV/STD - 449
Fact Sheets
STD-3
GC/Syph Serology Information Card
Warehouse
Forms
STD-42
Disclosure and Consent Form
Warehouse
Forms
STD-6F
Sexually Transmitted Disease Record-Female
HIV/STD - 104
Forms
E13-13176
Expedited Partner Therapy in Texas
HIV/STD - 783
Electronic File
STD-6M
Sexually Transmitted Disease Record-Male
HIV/STD - 104
Forms
E13-11903
Human Papillomavirus (HPV) Fact Sheet
HIV/STD - 449
Electronic File
TCADA-27
Sexually Transmitted Diseases and Hepatitis B and C in Three Drug Abuse Clinics in Texas
Mental Hlth/Sub Abuse 488
Electronic File
E13-11914
Syphilis Fact Sheet
HIV/STD - 449
Fact Sheets
E13-11916
Trichomoniasis Fact Sheet
HIV/STD - 449
Fact Sheets
E13-11887
Bacterial Vaginosis Fact Sheet
Fact Sheets Fact Sheets
Electronic File
E13-11917
Vaginitis Fact Sheet
HIV/STD - 449
E13-11919
Yeast (Thrush) Fact Sheet
HIV/STD - 449
Stock #4-25-lang Revised 10/25/2010
Page 141 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E6-47
What You Should Know About Gonorrhea
HIV/STD - 332
Electronic File
E13-12832
Texas Medical Monitoring Project Newsletter
HIV/STD Epidemiology 732
Electronic Newsletter/Magazine
E13-11886
What You Should Know About Trichomoniasis Fact Sheet
HIV/STD - 449
Electronic File
CDC73S
Field Record (Single) 73.2936S
Warehouse
Forms
E4-20-13
AIDS/Hepatitis/Sexually Transmitted Diseases/Tuberculosis Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E4-206
10 Questions About Pregnancy and HIV
HIV/STD - 332
Electronic File
E4-213
What About Your Partners? (Partner Notification)
HIV/STD - 332
Electronic File
4-227
If You Have a Rash on Your Hand (syphilis awareness poster)
Warehouse
Posters
CDC73W
CDC73.2936S Work Copy
Warehouse
Forms
E4-190
What You Should Know About HPV
HIV/STD - 332
Electronic File
ESTD-28
Notification of Laboratory Test Findings Indicating Presence of Chlamydia Trachomatis, Gonorrhea,...
HIV/STD - 734
Electronic File
E6-75
What You Should Know About Chlamydia
HIV/STD - 332
Electronic File
E4-214
What If I've Been Exposed to an STD? (Partner Notification)
HIV/STD - 332
Electronic File
E13-13369
Texas HIV/STD Prevention Community Planning Group: Questions and Answers
HIV/STD - 852
Electronic File
E13-11894
Hepatitis C Fact Sheet
HIV/STD - 449
Electronic File
E13-11890
STDs and Condoms Fact Sheet
HIV/STD - 449
Electronic File
E13-11893
Hepatitis B Fact Sheet
HIV/STD - 449
Electronic File
ESTD-42
Disclosure and Consent Form
HIV/STD - 734
Electronic File
E13-13263
HIV, Syphilis and Hepatitis B Testing for Pregnant Women
HIV/STD - 783
Electronic File
E13-11895
Hepatitis D Fact Sheet
HIV/STD - 449
Electronic File
E6-70
What You Should Know About Genital Herpes
HIV/STD - 332
Electronic File
E13-11897
Herpes Fact Sheet
HIV/STD - 449
Electronic File
E13-11889
Texas HIV/STD InfoLine Community Calls Program
HIV/STD - 449
Electronic File
E13-11888
Chlamydia Fact Sheet
HIV/STD - 449
Electronic File
Sickle Cell Anemia / Anemia drepanocitica Sickle Cell Disease: A Resource For the Educator
Newborn Screening - 313
Electronic File
05-10779
Sickle Cell Disease Affects Us All - Where Are Your Roots? (Limit 5)
Newborn Screening - 136
Posters
1-192
A Sickle Cell Coloring Book (Limit 5)
Warehouse
Coloring Books
E05-03870
Hemoglobin Sickle C Disease
Newborn Screening - 313
Electronic File
E05-03871
Sickle Beta Zero Thalassemia
Newborn Screening - 313
Electronic File
E05-03878
Splenic Sequestration Crisis
Newborn Screening - 313
Electronic File
E05-03945
Sickle Cell Anemia: A Parent's Guide For the School Age Child
Newborn Screening - 313
Electronic File
E05-10103
Hemoglobin E
Newborn Screening - 313
Electronic File
E05-03877
Chest Syndrome
Newborn Screening - 313
Electronic File
E05-03879
Priapism
Newborn Screening - 313
Electronic File
E05-03872
Sickle Beta+ Thalassemia
Newborn Screening - 313
Electronic File
E05-03873
Sickle Cell Anemia and Stroke
Newborn Screening - 313
Electronic File
Aplastic Crisis
Newborn Screening - 313
Electronic File
E05-10119
E05-03880
Stock #4-25-lang Revised 10/25/2010
Page 142 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E1-68
The Infant and Young Child with Sickle Cell Anemia: A Guide Especially for Parents
Newborn Screening - 313
Electronic File
E05-10378
Sickle Cell Disease and Sickle Cell Trait
Newborn Screening - 313
Electronic File
E05-10579
Sickle Cell Dis. in Children & Adolescents: Diagn., Gdlines for Comp. Care & Protocols for Mgt.
Newborn Screening - 313
Electronic File
E1-66
So Your Baby Has the Sickle Cell Trait
Newborn Screening - 313
Electronic File
E05-03874
Pain in the Child with Sickle Cell Disease
Newborn Screening - 313
Electronic File
E05-03875
Hemoglobin C Disease
Newborn Screening - 313
Electronic File
E05-03876
Pneumococcal Infection and Penicillin
Newborn Screening - 313
Electronic File
05-06442
A Sickle Cell Coloring Book (Limit 5)
Newborn Screening - 136
Coloring Books
Skin & Skin Diseases / Piel y Enfermedades de la piel E6-3
What To Do About Your Skin Infection
Infectious Disease - 400
Electronic File
5-13P
A Good Offense is Still the Best Defense
Warehouse
Posters
CD-001
Drug Therapy for Treatment of Hansen's Disease
Hansen's Disease - 83
Forms
E5-13
A Good Offense is Still the Best Defense
Infectious Disease - 602
Electronic File
E59-12421
Athletes-What To Do About Your Skin Infection
Infectious Disease - 602
Electronic File
EC-12
Texas Hansen’s Disease Surveillance Form and Case Report
Infectious Disease - 629
Electronic File
E59-12490
What You Need to Know About Staph/MRSA Skin Infections
Infectious Disease - 657
Electronic File
Smear/biopsy
Skin Smear/Biopsy Chart
Infectious Disease - 629
Electronic File
E6-5
Impetigo
Infectious Disease - 183
Electronic File
ECD-001
Drug Therapy for Treatment of Hansen's Disease
Infectious Disease - 629
Electronic File
F23-12526
Order Form - Tanning Warning Signs
Drugs & Medical Device 674
Forms
E59-12434
How to Take Care of Your Skin Infection
Infectious Disease - 602
Electronic File
HD-400
Texas Hansen's Disease Encounter Form
Hansen's Disease - 83
Forms
ECD-010
Disclosure and Consent Skin Biopsy for Hansen’s Disease Cases or Suspects
Infectious Disease - 629
Electronic File
EHDC-400
Texas Hansen's Disease Suspect/Contact Screen
Infectious Disease - 629
Electronic File
EHD-400
Texas Hansen's Disease Encounter Form
Infectious Disease - 629
Electronic File
EF23-12526
Order Form - Tanning Warning Signs
Drugs & Medical Device 675
Electronic File
EF12-11051
Hand Screen Record - Hansen's Disease
Infectious Disease - 629
Electronic File
EF12-11050
Foot Screen Record - Hansen's Disease
Infectious Disease - 629
Electronic File
EF11-10868
Rash Fever Illness Case Track Record
Infectious Disease - 727
Electronic File
Disclosure & Consent Skin Scraping for Hansen's Disease Cases or Suspects
Infectious Disease - 629
Electronic File
ECD-011
Smoking & Smokeless Tobacco / Fumar y Tabaco sin humo txtob03-6
Assessment of Texas School Capacity and Infrastructure for Tobacco Program Implem. 2 Years After
Substance Abuse Services - Electronic File Tobacco - 236
txtob03-5
Evaluation of the Texas Department of Health Texas Tobacco Prevention Pilot Initiative - Adults
Substance Abuse Services - Electronic File Tobacco - 236
txtob03-4
An Assessment of Community Capacity to Implement and Sustain Tobacco Programs in East Texas
Substance Abuse Services - Electronic File Tobacco - 236
txtob03-1
Health Insurance Coverage for Tobacco Dependence
Substance Abuse Services - Electronic File Tobacco - 236
TCADA-33
Fry: A Study of Adolescents' Use of Embalming Fluid with Marijuana and Tobacco
Mental Hlth/Sub Abuse 488
Stock #4-25-lang Revised 10/25/2010
Electronic File
Page 143 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
txtob03-3
Agency Capacity to Implement & Sustain Community-Based Tobacco Prevention & Control Prog.-East Texas
Substance Abuse Services - Electronic File Tobacco - 236
txtob03-2
Status of School Tobacco Prevention and Control Two Years after Tx Tobacco Prevent. Initiative
Substance Abuse Services - Electronic File Tobacco - 236
txtob03-7
Factors Influencing Scoring Decisions for Texas Municipal SHS Ordinances
Substance Abuse Services - Electronic File Tobacco - 236
E16-11187
Texans and Tobacco: A Report to the Texas Legislature
Substance Abuse Services - Electronic File Tobacco - 234
E29-12281
Frequently Asked Questions [Tobacco Settlement]
Funds Coordination - 572
E16-11993
Maybe I'm Thinking About Quitting
Substance Abuse Services - Electronic File Tobacco - 526
E16-11992
No, I'm Not Ready to Quit
Substance Abuse Services - Electronic File Tobacco - 526
E16-11991
Yes! I'm Ready to Quit
Substance Abuse Services - Electronic File Tobacco - 526
E16-11832
One-Year Assessment of the Impact of a Smoking Ban on Restaurant & Bar Revenues-El Paso
Substance Abuse Services - Electronic File Tobacco - 234
E16-11831
Texas Inter-agency Tobacco Task Force Legislative Plan
Substance Abuse Services - Electronic File Tobacco - 234
E4-194-html
No, I am not Ready to Quit
Substance Abuse Services - Electronic File Tobacco - 528
E16-11188
Texas Youth Tobacco Survey Reports
Substance Abuse Services - Electronic File Tobacco - 232
E16-11830
Progress on Achieving Texas Tobacco Reduction Goals: Report to 78th Legislature
Substance Abuse Services - Electronic File Tobacco - 234
E16-11186
Texas Tobacco Prevention Initiative Infrastructure and Baseline Data, Jan. 2001
Substance Abuse Services - Electronic File Tobacco - 236
E10-15J
ABCs of Health - Tobacco
Adult Health - 231
E10-12224
Tobacco and Cancer in Texas
Cancer Epi/Surv - 111
Electronic File
4-199
State Employees-Free NRT (Texas state agency staff ONLY)
Warehouse
Posters
4-192
Troy Aikman Anti-Spit-Tobacco poster
Warehouse
Posters
16-11730
Texas Youth Tobacco Awareness Program Instructor Directory
Substance Abuse Services - Directories Tobacco - 25
E16-11829
Impact of Clean Indoor Air Ordinances on Restaurant Revenues in 4 Texas Cities
Substance Abuse Services - Electronic File Tobacco - 234
F29-12280
Pro Rata Tobacco Settlement Distribution County Expenditure Statement
Funds Coordination - 571
E16-11193
Texas Inter-agency Tobacco Task Force Legislative Plan, November 1998
Substance Abuse Services - Electronic File Tobacco - 234
txtob01-2
Operation Storefront: Observations of Texas Retailer Tobacco Advertising/Tobacco Laws Compliance
Substance Abuse Services - Electronic File Tobacco - 236
E16-11192
Texas Tobacco Prevention Initiative Media Campaign & Comm. Progr. Effects Among Children & Adults
Substance Abuse Services - Electronic File Tobacco - 236
txtob01-4
Judicial Attitudes and Dispositions Toward Texas Tobacco Laws, January 2001
Substance Abuse Services - Electronic File Tobacco - 236
E4-195-html
Maybe I am Ready to Quit
Substance Abuse Services - Electronic File Tobacco - 527
F29-12279
Pro Rata Tobacco Settlement Distribution Hospital District Hospital Expenditure Statement
Funds Coordination - 571
Forms
F29-12278
Pro Rata Tobacco Settlement Distribution Non-Hospital District Public Hospital Expenditure Statement
Funds Coordination - 571
Forms
EF29-12280
Pro Rata Tobacco Settlement Distribution County Expenditure Statement
Funds Coordination - 572
Electronic File
txtob01-3
Law Enforcement Officer Attitudes Toward Texas Tobacco Laws & Tobacco Enforcement Activities
Substance Abuse Services - Electronic File Tobacco - 236
Stock #4-25-lang Revised 10/25/2010
Electronic File
Electronic File
Forms
Page 144 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF29-12279
Pro Rata Tobacco Settlement Distribution Hospital District Hospital Expenditure Statement
Funds Coordination - 572
Electronic File
EF29-12278
Pro Rata Tobacco Settlement Distribution Non-Hospital District Public Hospital Expenditure Statement
Funds Coordination - 572
Electronic File
E54-13252
Region 7 Tobacco Prevention and Control Newsletter
Region 7 - Tobacco Prevent - 828
Electronic Newsletter/Magazine
E4-20-17
Smoking and Smokeless Tobacco Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E4-196-html
Yes, I am Ready to Quit
Substance Abuse Services - Electronic File Tobacco - 525
Social Work / Trabajo social F77-11659
St Bd of Social Worker Exam-Application to be a Supervisor
Tx State Bd of Social Worker Examiners - 337
Forms
EF77-11661
St Bd of Social Worker Exam-Supervision Plan
Tx State Bd of Social Worker Examiners - 358
Electronic File
EF77-11662
St Bd of Social Worker Exam-Supervision Verification for SWA (Social Worker Associate)
Tx State Bd of Social Worker Examiners - 358
Electronic File
F73-10747
Texas State Board of Examiners of Marriage & Family Therapists References Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-10748
Texas State Board of Examiners of Marriage & Family Therapists Application Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-10751
Tx St Bd of Examiners of Marriage & Family Therapists -Supervised Experience Doc Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-10752
Tx St Bd of Examiners of Marriage and Family Therapists Supervisor Application
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F73-10753
Tx St Bd of Examiners of Marriage and Family Therapists Supervisory Agreement Form
Tx St Bd of Examrs of Marr & Fam Therapists 187
Forms
F75-10966
St Bd of Exam of Prof Counselors-Supervisor Application Form
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F75-10967
St Bd of Exam of Prof CounselorsSupervisory Agreement Form
Tx St. Bd of Examiners of Prof Counselors - 128
Forms
F77-11660
St Bd of Social Worker Exam-Social Work License Renewal Form
Tx State Bd of Social Worker Examiners - 337
Forms
F77-10802
Texas State Board of Social Worker Examiners - CEU Provider Appl Proc Packet
Tx State Bd of Social Worker Examiners - 93
Forms
EF77-11660
St Bd of Social Worker Exam-Social Work License Renewal Form
Tx State Bd of Social Worker Examiners - 358
Electronic File
F77-11662
St Bd of Social Worker Exam-Supervision Verification for SWA (Social Worker Associate)
Tx State Bd of Social Worker Examiners - 337
Forms
F77-11661
St Bd of Social Worker Exam-Supervision Plan
Tx State Bd of Social Worker Examiners - 337
Forms
EF77-11663
St Bd of Social Worker Exam-Supervision Verification for Adv Clinical Practitioner/Adv Pra (ACP/AP)
Tx State Bd of Social Worker Examiners - 358
Electronic File
F77-11663
St Bd of Social Worker Exam-Supervision Verification for Adv Clinical Practitioner/Adv Pra (ACP/AP)
Tx State Bd of Social Worker Examiners - 337
Forms
F77-10801
ACP/AP Supervision Forms Packet (Texas State Board of Social Worker Examiners)
Tx State Bd of Social Worker Examiners - 93
Forms
EF73-12433
MFT CE Provider Approval Application/Renewal Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 145 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF73-10748
Texas State Board of Examiners of Marriage & Family Therapists Application Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-10747
Texas State Board of Examiners of Marriage & Family Therapists References Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-10752
Tx St Bd of Examiners of Marriage and Family Therapists Supervisor Application
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF73-10753
Tx St Bd of Examiners of Marriage and Family Therapists Supervisory Agreement Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
E77-10805
Board Bulletin (Texas State Board of Social Worker Examiners)
Tx State Bd of Social Worker Examiners - 380
Electronic Newsletter/Magazine
E77-11356
A Consumer's Guide to Social Work Licensing
Tx State Bd of Social Worker Examiners - 358
Electronic File
EF73-10751
Tx St Bd of Examiners of Marriage & Family Therapists -Supervised Experience Doc Form
Tx St Bd of Examrs of Marr & Fam Therapists 460
Electronic File
EF77-11659
St Bd of Social Worker Exam-Application to be a Supervisor
Tx State Bd of Social Worker Examiners - 358
Electronic File
EF75-10966
St Bd of Exam of Prof Counselors-Supervisor Application Form
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
E77-10021
Continuing Education Requirements for Social Work Licensing
Tx State Bd of Social Worker Examiners - 358
Electronic File
EF75-10967
St Bd of Exam of Prof CounselorsSupervisory Agreement Form
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
EF77-10801
ACP/AP Supervision Forms Packet (Texas State Board of Social Worker Examiners)
Tx State Bd of Social Worker Examiners - 358
Electronic File
Spinal Screening / Examen sistematico de la medula espinal E1-111
Spinal Screening Program Guidelines (same as publication #E0502452)
Vision, Hearing and Spinal Screening - 699
Electronic File
E05-02452
Spinal Screening Program Guidelines (same as publication #E1-111)
Vision, Hearing and Spinal Screening - 699
Electronic File
Athletic Trainer License Application Packet
Advisory Board of Athletic Trainers - 121
Forms
ABCs of Health - Stress
Adult Health - 231
Electronic File
Sports Medicine / Medicina de los deportes F60-10681
Stress / Estres E10-15K
Substance Abuse / Abuso de sustancias E103-12185
Access to Recovery Through Drug Courts
Access to Recovery - 530
Electronic File
E02-12783
Licensed Chemical Dependency Counselor Program Rules
Licensed Chemical Dependency Counselor 717
Electronic File
E29-12477
Access to Recovery 2007 General Provisions
Client Services Contracting - 617
Electronic File
TCADA-15
Texas Survey of Substance Use Among University Students
Mental Hlth/Sub Abuse 486
Electronic File
TCADA-14
Substance Use Among Students in Texas Secondary Schools
Mental Hlth/Sub Abuse 485
Electronic File
TCADA-1
Perceived Environmental Safety and Substance Use
Mental Hlth/Sub Abuse 485
Electronic File
TCADA-11
Substance Use Among Youths at High Risk of Dropping Out: Grades 7-12 in Texas
Mental Hlth/Sub Abuse 485
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 146 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
TCADA-12
Texas School Survey of Substance Use Among Students on the Border: Grades 4-12
Mental Hlth/Sub Abuse 485
Electronic File
E02-12215
Licensed Chemical Dependency Counselor Handbook
Licensed Chemical Dependency Counselor 535
Electronic File
TCADA-13
Being Drug Free: Resillency Factors in Texas Youth
Mental Hlth/Sub Abuse 485
Electronic File
TCADA-7
Substance Use and Delinquency Among Youths Entering Texas Youth Commission Facilities
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-8
Survey of Substance Use on the Texas-Mexico Border and in Colonias
Mental Hlth/Sub Abuse 487
Electronic File
TCADA-24
DWI Recidivism in Texas
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-43
Texas Survey of Postpartum Women and Drug-Exposed Infants
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-33
Fry: A Study of Adolescents' Use of Embalming Fluid with Marijuana and Tobacco
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-32
An Ethnographic Study of Mexican American Inhalant Abusers in San Antonio, Texas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-31
An Ethnographic Comparison of the Mexican American Drug Culture in El Paso, Texas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-30
Need in Texas for Range of Services of Chemically Dependent Adults
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-3
Economic Costs of Alcohol and Drug Abuse in Texas
Mental Hlth/Sub Abuse 493
Electronic File
TCADA-28
Leaning on Syrup: The Misuse of Opioid Cough Syrup in Houston
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-35
Crack Cocaine as a Major Risk of HIV Transmission in a Crack House Population
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-25
Substance Use Among Texas Department of Corrections Inmates
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-36
Understanding Inhalant Users: An Overview for Parents, Educators, and Clinicians
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-23
Substance Use and Crime Among Probationers in Three Texas Counties
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-22
Substance Use and Crime in Texas
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-20
Substance Use Among Male Inmates TDCJ-Institutional Division
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-2
Substance Abuse Trends in Texas
Mental Hlth/Sub Abuse 484
Electronic File
TCADA-19
Substance Use Among Female Inmates TDCJ-Institutional Division
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-18
Substance Use Among Male Inmates TDCJ-State Jail Division
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-17
Substance Use Among Female Inmates TDCJ-State Jail Division
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-26
GHB Withdrawal Syndrome
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-47
Current Trends in Substance Use in Texas
Mental Hlth/Sub Abuse 490
Electronic File
TCADA-57
Comparative Pharmacological Profiles of Abused Drugs
Mental Hlth/Sub Abuse 497
Electronic File
TCADA-56
Substance Abuse Pilot Treatment Program for Criminal Offenders: Summary Report
Mental Hlth/Sub Abuse496
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 147 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
TCADA-55
Characteristics of Substance Abuse Clients in the State Mental Hospitals & Clients in Community-Base
Mental Hlth/Sub Abuse496
Electronic File
TCADA-54
A Guide for Selecting Substance Abuse Screening and Assessment Instruments
Mental Hlth/Sub Abuse496
Electronic File
TCADA-53
Substance Abuse Treatment Outcome Study
Mental Hlth/Sub Abuse496
Electronic File
TCADA-16
Substance Abuse Among Offenders Entering TDCJ-State Abuse Felony Punishment Facilities
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-34
Comparison of Patterns of Illicit Drug Use in Australia and the United States
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-5
Texas School Survey of Substance Abuse Among Students: Grades 712
Mental Hlth/Sub Abuse 485
Electronic File
TCADA-6
Texas Survey of Substance Use Among Adults
Mental Hlth/Sub Abuse 487
Electronic File
TCADA-21
Substance Use Among Male Inmates TDCJ-Institutional DivisionExecutive Summary
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-42
The Rave Scene in Houston, Texas: An Ethnographic Analysis
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-41
The History of Drug Abuse in Texas, Selected Metropolitan Areas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-40
Patterns of Volatile Substance Abuse Among the Kickapoo People in Eagle Pass, Texas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-4
Texas School Survey of Substance Use Among Students: Grades 4-6
Mental Hlth/Sub Abuse 485
Electronic File
TCADA-39
Heroin Abuse Trends in Texas and Results on the 1994 Survey of Methadone Programs
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-38
An Ethnographic Study of Heroin Abuse by Mexican Americans in San Antonio, Texas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-37
Methadone in Texas: Analysis of Treatment, Arrest, and Overdose Data
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-51
Indicators of Alcohol and Drug Abuse In Texas
Mental Hlth/Sub Abuse 491
Electronic File
Teenage Pregnancy / Embarazo adolescente E13-102
Give Your Baby the Best Start
Nutrition Services - 570
Electronic File
E35-10559
Texas Vital Statistics Annual Report
Center for Health Statistics - 107
Electronic File
EBVS013
Vital Statistics Annual Report 1998
Center for Health Statistics - 107
Electronic File
Texas Commission on Alcohol and Drug Abuse / Comision de Alcohol y Abuso de Drogas de Texas TCADA-4
Texas School Survey of Substance Use Among Students: Grades 4-6
Mental Hlth/Sub Abuse 485
Electronic File
TCADA-34
Comparison of Patterns of Illicit Drug Use in Australia and the United States
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-35
Crack Cocaine as a Major Risk of HIV Transmission in a Crack House Population
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-36
Understanding Inhalant Users: An Overview for Parents, Educators, and Clinicians
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-37
Methadone in Texas: Analysis of Treatment, Arrest, and Overdose Data
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-39
Heroin Abuse Trends in Texas and Results on the 1994 Survey of Methadone Programs
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-1
Perceived Environmental Safety and Substance Use
Mental Hlth/Sub Abuse 485
Electronic File
TCADA-40
Patterns of Volatile Substance Abuse Among the Kickapoo People in Eagle Pass, Texas
Mental Hlth/Sub Abuse 488
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 148 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
TCADA-38
An Ethnographic Study of Heroin Abuse by Mexican Americans in San Antonio, Texas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-33
Fry: A Study of Adolescents' Use of Embalming Fluid with Marijuana and Tobacco
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-31
An Ethnographic Comparison of the Mexican American Drug Culture in El Paso, Texas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-41
The History of Drug Abuse in Texas, Selected Metropolitan Areas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-10
Texas School Survey (Texas Commission on Alcohol and Drug Abuse)
Mental Hlth/Sub Abuse 485
Electronic File
TCADA-30
Need in Texas for Range of Services of Chemically Dependent Adults
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-11
Substance Use Among Youths at High Risk of Dropping Out: Grades 7-12 in Texas
Mental Hlth/Sub Abuse 485
Electronic File
TCADA-12
Texas School Survey of Substance Use Among Students on the Border: Grades 4-12
Mental Hlth/Sub Abuse 485
Electronic File
TCADA-9
Why People Don't Use Illicit Drugs
Mental Hlth/Sub Abuse 487
Electronic File
TCADA-32
An Ethnographic Study of Mexican American Inhalant Abusers in San Antonio, Texas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-53
Substance Abuse Treatment Outcome Study
Mental Hlth/Sub Abuse496
Electronic File
TCADA-55
Characteristics of Substance Abuse Clients in the State Mental Hospitals & Clients in Community-Base
Mental Hlth/Sub Abuse496
Electronic File
TCADA-8
Survey of Substance Use on the Texas-Mexico Border and in Colonias
Mental Hlth/Sub Abuse 487
Electronic File
TCADA-3
Economic Costs of Alcohol and Drug Abuse in Texas
Mental Hlth/Sub Abuse 493
Electronic File
TCADA-6
Texas Survey of Substance Use Among Adults
Mental Hlth/Sub Abuse 487
Electronic File
TCADA-58
A Dictionary of Slang Drug Terms, Their Generic and Trade Names, and Pharmacological Effects and Use
Mental Hlth/Sub Abuse 497
Electronic File
TCADA-57
Comparative Pharmacological Profiles of Abused Drugs
Mental Hlth/Sub Abuse 497
Electronic File
TCADA-24
DWI Recidivism in Texas
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-7
Substance Use and Delinquency Among Youths Entering Texas Youth Commission Facilities
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-54
A Guide for Selecting Substance Abuse Screening and Assessment Instruments
Mental Hlth/Sub Abuse496
Electronic File
TCADA-42
The Rave Scene in Houston, Texas: An Ethnographic Analysis
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-51
Indicators of Alcohol and Drug Abuse In Texas
Mental Hlth/Sub Abuse 491
Electronic File
TCADA-5
Texas School Survey of Substance Abuse Among Students: Grades 712
Mental Hlth/Sub Abuse 485
Electronic File
TCADA-47
Current Trends in Substance Use in Texas
Mental Hlth/Sub Abuse 490
Electronic File
TCADA-46
Texas Survey of Adult Gambling Behavior
Mental Hlth/Sub Abuse 489
Electronic File
TCADA-45
Texas Survey of Adolescent Gambling Behavior
Mental Hlth/Sub Abuse 489
Electronic File
TCADA-44
Texas Survey of Adult and Adolescent Gambling Behavior
Mental Hlth/Sub Abuse 489
Electronic File
TCADA-43
Texas Survey of Postpartum Women and Drug-Exposed Infants
Mental Hlth/Sub Abuse 488
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 149 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
TCADA-56
Substance Abuse Pilot Treatment Program for Criminal Offenders: Summary Report
Mental Hlth/Sub Abuse496
Electronic File
TCADA-15
Texas Survey of Substance Use Among University Students
Mental Hlth/Sub Abuse 486
Electronic File
TCADA-29
Heroin Addicts in Texas: The Nature and Size of a Hidden Population
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-19
Substance Use Among Female Inmates TDCJ-Institutional Division
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-18
Substance Use Among Male Inmates TDCJ-State Jail Division
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-17
Substance Use Among Female Inmates TDCJ-State Jail Division
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-28
Leaning on Syrup: The Misuse of Opioid Cough Syrup in Houston
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-16
Substance Abuse Among Offenders Entering TDCJ-State Abuse Felony Punishment Facilities
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-2
Substance Abuse Trends in Texas
Mental Hlth/Sub Abuse 484
Electronic File
TCADA-21
Substance Use Among Male Inmates TDCJ-Institutional DivisionExecutive Summary
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-20
Substance Use Among Male Inmates TDCJ-Institutional Division
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-22
Substance Use and Crime in Texas
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-23
Substance Use and Crime Among Probationers in Three Texas Counties
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-13
Being Drug Free: Resillency Factors in Texas Youth
Mental Hlth/Sub Abuse 485
Electronic File
TCADA-25
Substance Use Among Texas Department of Corrections Inmates
Mental Hlth/Sub Abuse 494
Electronic File
TCADA-27
Sexually Transmitted Diseases and Hepatitis B and C in Three Drug Abuse Clinics in Texas
Mental Hlth/Sub Abuse 488
Electronic File
TCADA-14
Substance Use Among Students in Texas Secondary Schools
Mental Hlth/Sub Abuse 485
Electronic File
Texas Department of State Health Services / Departamento Estatal de Servicios de Salud de Texas E19-10515
DSHS Staff News (formerly Pulse Monitor)
Communications - 393
MH-4
Texas Crisis Consortium Brochure
Mental Health - 499
Electronic File
E19-11480
Texas Register Section Miscellaneous Notices Procedures
Office of General Counsel - 408
Electronic File
E4-25-ordering
Texas Department of State Health Services Publications CatalogOrdering Instructions
Publications Management Program - 86
Electronic File
ED-12
Organization Chart - Texas Department of State Health Services
Web Technology Services - 85
Electronic File
EF32-10544
Request for Publication Number Form
Publications Management Program - 86
Electronic File
E19-11479
Texas Register Section Open Meetings Procedures
Office of General Counsel - 408
Electronic File
EF49-11633
Model Hazcom Program (for Public Employers in Texas subject to Texas Hazard Communication Act)
Envir Hlth-PSQA - 55
Electronic File
E19-11080
County and Regions of Texas map
Web Technology Services - 740
Electronic File
MH-3
Helping Texas Communities When Disaster Strikes
Mental Health - 499
Electronic File
MH-2
Taking Care of Your Mental Health
Mental Health - 499
Electronic File
MH-1
Handbook of Consumer Rights Mental Health
Mental Health - 499
Electronic File
Stock #4-25-lang Revised 10/25/2010
Electronic File
Page 150 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EORLIST
Open Records Checklist
Off. of Gen. Counsel - 115
E16-11830
Progress on Achieving Texas Tobacco Reduction Goals: Report to 78th Legislature
Substance Abuse Services - Electronic File Tobacco - 234
E13-11884
Texas Perinatal HIV Transmission Epidemiologic Profile
HIV/STD - 447
EF32-12236
Destruction/Disposition of Records (Disposition Log adopted by HHS Enterprise)
Records Management - 204 Electronic File
50-11436
Preparedness Planning Review (Bioterrorism Planning Review Newsletter)
HSR 1 - Public Health Preparedness - 159
E25-12504
Texas State Health Plan Update 2007-2008
Statewide Health Electronic File Coordinating Council - 172
E19-11481
Texas Register Section Guidelines on Rule Making Procedures
Office of General Counsel - 408
Electronic File
E09-12915A
Processo Evaluacion de salud publica (Public Health Assessment Process)
Hlth Assessment/Toxicology 754
Electronic File
E44-11957
Comprehensive Cancer Control in Texas: 1998-2002 Final Report
Comprehensive Cancer Control - 212
Electronic File
E09-12915
Public Health Assessment Process
Hlth Assessment/Toxicology 754
Electronic File
E10-11756
Cancer Registry Electronic Submission System (CRESS) Instructions
Cancer Epi/Surv - 244
Electronic File
E50-11436
Preparedness Planning Review (Bioterrorism Planning Review Newsletter)
HSR 1 - Public Health Preparedness - 160
Electronic Newsletter/Magazine
E75-11652
What to Expect from your Licensed Professional Counselor (LPC brochure)
Tx St. Bd of Examiners of Prof Counselors - 360
Electronic File
E10-66
Breast and Cervical Cancer Services (BCCS) Brochure
Breast & Cervical Cancer 749
Electronic File
E90-11514
Health of Texans: Texas State Strategic Health Plan Part I
Prog Coord, Policy & Innov - 101
Electronic File
E10-66A
Cancer de mama y de cuello de utero servicios folleto (Breast/Cervical Cancer Services brochure
Breast & Cervical Cancer 749
Electronic File
EAG-39
DSHS Facilities Location Map (DSHS Main Campus Map)
Web Technology Services - 82
Electronic File
AG-11
DSHS Location Map (Austin DSHS Facilities Information Map)
Executive & Staff Operations - 39
Maps
AG-39
DSHS Facilities Location Map (DSHS Main Campus Map)
Executive & Staff Operations - 39
Maps
E88-11513
Public Health Improvement Plan
Prog Coord, Policy & Innov - 101
Electronic File
E88-11695
The Declaration for Health: Texas State Strategic Health Plan, Part III
Prog Coord, Policy & Innov - 101
Electronic File
E13-11275
Texas HIV/STD Surveillance Report
HIV/STD - 447
Electronic File
E88-13403
Catalyst Newsletter
Prog Coord, Policy & Innov- 856
Electronic Newsletter/Magazine
E44-10831
1998-99 Biennial Report of the Osteoporosis Advisory Committee
Osteoporosis - 225
Electronic File
E90-11515
Health of Texans: Texas State Strategic Health Plan Part I-Executive Summary
Prog Coord, Policy & Innov - 101
Electronic File
EAG-11
DSHS Location Map (Austin DSHS Facilities Information Map)
Web Technology Services - 81
Electronic File
EAG-30
Texas Department of State Health Services Requisition for Office Supplies/Forms/Literature
Publications Management Program - 86
Electronic File
E4-25-subject
Texas Department of State Health Services Publications Catalog-by Subject Heading
Publications Management Program - 86
Electronic File
ECOMPHAND
Computer Usage Handbook
Information Systems - 473
Electronic File
Stock #4-25-lang Revised 10/25/2010
Electronic File
Electronic File
Newsletters
Page 151 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E29-11833
General Provisions (Independent)
Client Services Contracting - 437
Electronic File
E41-10978
Kidney Health Care Rules
Kidney Health Care - 776
Electronic File
E25-12087
Texas State Health Plan 2005-2010
Statewide Health Electronic File Coordinating Council - 172
E41-10766
Kidney Health Care Annual Report
Kidney Health Care - 775
E25-12088
Texas State Health Plan 2005-2010-Executive Summary
Statewide Health Electronic File Coordinating Council - 172
E39-11284
Texas Department of State Health Services Operating Budget
Budget - 312
Electronic File
E25-11420
Healthy People 2000 Health Status Indicators by Texas Public Health Regions
Center for Health Statistics - 477
Electronic File
E39-10673
Legislative Appropriations Request
Budget - 97
Electronic File
E25-11399
The State of Telemedicine and Telehealth in Texas
Statewide Health Electronic File Coordinating Council - 666
E21-13122
Policy and Procedures Manual for Primary Health Care Services
Primary Health Care - 801
Electronic File
E32-10746
Texas Department of State Health Services Acronym List
Medical & Research Library - 215
Electronic File
E25-12095
Reports on Nursing Workforce and Nursing Education (October, 2004)
Ctr for Health Statistics 181
Electronic File
E29-11525
Financial Administrative Procedures Manual
Contract Oversight & Support - 389
Electronic File
E29-11836
General Provisions (IAC) Interagency Contracts
Client Services Contracting - 437
Electronic File
E29-11835
General Provisions (Fee-for-Service)
Client Services Contracting - 437
Electronic File
E29-11834
General Provisions (LGS) Local Government Services
Client Services Contracting - 437
Electronic File
E25-12096
Executive Summaries of Reports on Nursing Workforce and Nursing Education (October, 2004)
Ctr for Health Statistics 181
Electronic File
E25-10956
Migration for Birth
Center for Health Statistics - 188
Electronic File
E21-13477
Texas Title V Needs Assessment for the Maternal and Child Health Services Title V Block Grant Prog
Title V - 882
Electronic File
E4-25-language
Texas Department of State Health Services Publications Catalog-by Language
Publications Management Program - 86
Electronic File
E4-25-format
Texas Department of State Health Services Publications Catalog-by Format
Publications Management Program - 86
Electronic File
E4-25-contact
Texas Department of State Health Services Publications CatalogContact Information
Publications Management Program - 86
Electronic File
E24-11945
Promotor(a) or Community Health Worker Training and Certification Program - Annual Report
Community Hlth Wrkr 371
Electronic File
E4-24
DSHS Records Handbook
Records Management Program - 214
Electronic File
E25-13076
2009-2010 Texas State Health Plan Update
Statewide Health Electronic File Coordinating Council - 172
E4-21
DSHS Staff Development Audiovisual Catalog
Audiovisual Library - 196
Electronic File
E25-10990
Aging Texas Well 1999: A Health Perspective
Prog Coord, Policy & Innov - 101
Electronic File
E4-187
Strategic Plan
Prog Coord, Policy & Innov- 785
Electronic File
E41-13123
Policy and Procedures Manual for Epilepsy Services
Epilepsy Services - 799
Electronic File
E25-11019
Selected Demographic and Public Health Measures: Rankings for Texas Counties
Center for Health Statistics - 665
Electronic File
Stock #4-25-lang Revised 10/25/2010
Electronic File
Page 152 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E41-11440
Texas Department of State Health Services Epilepsy Program Rules
Epilepsy Services - 427
Electronic File
E4-25-alpha
Texas Department of State Health Services Publications Catalog-by Alphabetical Listing
Publications Management Program - 86
Electronic File
Texas Health Care Information Council / Consejo de Informacion sobre la Atencion Medica de Texas E25-12462
THCIC Hospital Numbered Letters Volume 6
Tx Hlth Care Info Collection - 724
Electronic File
E25-12470
The Cost of Cancer in Texas
Tx Hlth Care Info Collection - 301
Electronic File
E25-12451
THCIC Hospital Certifications Manual Version 1.0
Tx Hlth Care Info Collection - 649
Electronic File
E25-12452
THCIC Hospital Data Corrections Manual Version 1.0
Tx Hlth Care Info Collection - 649
Electronic File
EF25-12466
Research Data Dictionary; Research Data Use Agreement; Research Data Request Form
Tx Hlth Care Info Collection - 407
Electronic File
E25-12453
Hospital Discharge Data Collection THCIC 837 Technical Specifications Ver 15
Tx Hlth Care Info Collection - 649
Electronic File
EF25-12456
Update Information About Your Hospital
Tx Hlth Care Info Collection - 649
Electronic File
E25-12471
Utilization of Specific Inpatient Procedures by Texas Hospital Referral Region
Tx Hlth Care Info Collection - 301
Electronic File
E25-12454
Hospital Discharge Data Collection Hospital Procedures & Technical Specifications Appendicies Ver 14
Tx Hlth Care Info Collection - 649
Electronic File
E25-12457
THCIC Hospital Numbered Letters Volume 1
Tx Hlth Care Info Collection - 724
Electronic File
E25-12474
Your HMO Quality Checkup (Regional Reports)
Tx Hlth Care Info Collection - 406
Electronic File
E25-12458
THCIC Hospital Numbered Letters Volume 2
Tx Hlth Care Info Collection - 724
Electronic File
E25-12464
THCIC Hospital Numbered Letters Volume 8
Tx Hlth Care Info Collection - 724
Electronic File
E25-12465
THCIC Hospital Numbered Letters Volume 9
Tx Hlth Care Info Collection - 724
Electronic File
E25-12466
THCIC Hospital Submitter / Provider Enrollment Manual Version 1.0
Tx Hlth Care Info Collection - 649
Electronic File
E25-12459
THCIC Hospital Numbered Letters Volume 3
Tx Hlth Care Info Collection - 724
Electronic File
E25-12460
THCIC Hospital Numbered Letters Volume 4
Tx Hlth Care Info Collection - 724
Electronic File
E25-12461
THCIC Hospital Numbered Letters Volume 5
Tx Hlth Care Info Collection - 724
Electronic File
E25-12468
Top 25 Diagnoses, All-Patient Refined Diagnostic Related Groups (APR-DRGs)
Tx Hlth Care Info Collection - 301
Electronic File
E25-12473
Your HMO Quality Check-up (Medicare Reports)
Tx Hlth Care Info Collection - 406
Electronic File
E25-12467
THCIC Secured Server Procedures Manual Version 1.0
Tx Hlth Care Info Collection - 649
Electronic File
E25-12463
THCIC Hospital Numbered Letters Volume 7
Tx Hlth Care Info Collection - 724
Electronic File
E25-12472
Your HMO Quality Check-up (Medicaid Reports)
Tx Hlth Care Info Collection - 406
Electronic File
E25-12437
Indicators of Inpatient Care in Texas Hospitals, 2004
Tx Hlth Care Info Collection - 723
Electronic File
E25-11774
Top 25 Diagnoses, Health Care Financing Administration Diagnostic Related Groups (HCFA-DRGs)
Tx Hlth Care Info Collection - 301
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 153 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E25-12455
THCIC Hospital HyperTerminal Setup Manual Version 1.0
Tx Hlth Care Info Collection - 649
Electronic File
E25-12450
THCIC Audit List
Tx Hlth Care Info Collection - 649
Electronic File
E25-12435
Commercial Product Basic Service HMOs
Tx Hlth Care Info Collection - 647
Electronic File
E25-12436
Indicators of Inpatient Care in Texas Hospitals, 2003
Tx Hlth Care Info Collection - 648
Electronic File
E25-12440
Exemption for HEDIS Reporting (Critieria)
Tx Hlth Care Info Collection - 647
Electronic File
E25-12443
Preventable Hospitalizations in Texas, 2002
Tx Hlth Care Info Collection - 301
Electronic File
E25-12444
Public Use Data File User Manual; PUDF Data Use Agreement; PUDF Order Form
Tx Hlth Care Info Collection - 407
Electronic File
E25-12445
Hospital Listings
Tx Hlth Care Info Collection - 649
Electronic File
E25-12447
Straight Talk on Texas HMOs
Tx Hlth Care Info Collection - 406
Electronic File
E25-12449
THCIC 837 Claim-Technical Discussion (Creating Data in THCIC 8317-Discussion Notes)
Tx Hlth Care Info Collection - 649
Electronic File
E25-12448
Texas Subset of HEDIS 2007
Tx Hlth Care Info Collection - 647
Electronic File
Travel Office - 333
Electronic File
Texas State Agencies / Agencias estatales de Texas CPA-TRAVALL
Comptroller's Travel Allowance Guide
Tuberculosis / Tuberculosis ETB-411
Disclosure and Consent Drug Therapy for Treatment of Tuberculosis Disease
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-410B
Order to Implement and Carry Out Measures for Children with TB/Orden para implementar medidas
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-410
Order to Implement and Carry Out Measures for a Client with TB
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-409
Acknowledgement of Understanding (Tuberculosis Elimination)
Infectious Disease Control Unit - TB - 320
Electronic File
TB-412
Tuberculosis Surveillance Form
Warehouse
Forms
TB-318
Positive Reactor Worksheet
Warehouse
Forms
TB-280
Chest Clinic Appointment Card
Warehouse
Forms
TB-340
Report of TB Contacts (Limit order 500)
Warehouse
Forms
TB-231
Bacteriology TB Control
Warehouse
Forms
TB-220
Referral Form (TB)
Warehouse
Forms
TB-341
Continuation of Report of Contacts (Limit order 500)
Warehouse
Forms
TB-208
Tuberculosis Contact Screening Form
Warehouse
Forms
TB-400A
Report of Case/Patient Services, Part A (Limit order 500)
Warehouse
Forms
TB-400B
Report of Case/Patient Services, Part B (Limit order 500)
Warehouse
Forms
TB-202
Tuberculosis Health Assessment/History
Warehouse
Forms
TB-207
Targeted Tuberculin Testing Screening Form
Warehouse
Forms
ETB-415
Disclosure and Consent Drug Therapy for Treatment of Latent Tuberculosis (TB) Infection
Infectious Disease Control Unit - TB - 320
Electronic File
TB-206
Directly Observed Therapy Log
Warehouse
Forms
Disclosure and Consent Drug Therapy for Treatment of Latent Tuberculosis (TB) Infection
Warehouse
Forms
TB-415
Stock #4-25-lang Revised 10/25/2010
Page 154 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
TB-205
Tuberculosis Elimination Toxicity Assessment
Warehouse
Forms
ETB-400B
Report of Case/Patient Services, Part B
Infectious Disease Control Unit - TB - 320
Electronic File
TB-204
Forms/Literature Checklist
Warehouse
Forms
TB-203
Tuberculosis Education/Counseling Record
Warehouse
Forms
TB-201
Case Management Plan for Outpatient Care
Warehouse
Forms
TB-621
Preventive Treatment Record
Infectious Disease Control Unit - TB - 253
Forms
TB-622
Treatment Record
Infectious Disease Control Unit - TB - 253
Forms
TB-411
Disclosure and Consent for Drug Therapy-TB
Warehouse
Forms
EF12-11461
Positive PPD/Suspects and/or Cases
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-12168
Monthly Tuberculin Skin Testing Form
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-12105
PPD Agreement for Texas Health Steps Providers
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-12104
TB Incident Report
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-12062
Contact Investigation Worksheet (temporarily unavailable)
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-11494
TB Questionnaire (English)
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-12478
Mycobacterium tuberculosis Genotyping Request Form
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-11462
Monthly Correctional TB Report
Infectious Disease Control Unit - TB - 320
Electronic File
E4-20-13
AIDS/Hepatitis/Sexually Transmitted Diseases/Tuberculosis Audiovisual Catalog
Audiovisual Library - 196
Electronic File
EF12-11358
Binational Status Report (TB)
Infectious Disease Control Unit - TB - 320
Electronic File
E13-11915
TB Fact Sheet
HIV/STD - 449
Fact Sheets
E12-12952
Completing Correctional Tuberculosis Reports
Infectious Disease Control Unit - TB - 320
Electronic File
E12-11848
Standards of Performance (Tuberculosis Elimination) Under revisionnot available
Infectious Disease Control Unit - TB - 373
Electronic File
ETB-400A
Report of Case/Patient Services, Part A
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-12274
Report of Serious Adverse Drug Reaction Resulting in Hospitalization or Death
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-11463
Correctional Tuberculosis Screening Plan
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-205
Clinical Assessment for Medication Toxicity
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-12499
Contact Investigation Concentric Circle Diagram
ETB-318
Tuberculin Skin Test Pediatric Positive Reactor Worksheet
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-340
Report of TB Contacts
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-231
Bacteriology TB Control
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-208
Tuberculosis Contact Screening Form
Infectious Disease Control Unit - TB - 320
Electronic File
Stock #4-25-lang Revised 10/25/2010
Electronic File
Page 155 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
ETB-341
Continuation of Report of Contacts
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-206
Directly Observed Therapy Log
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-220
Referral Form (TB)
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-204
Tuberculosis Forms/Literature Checklist
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-203
Tuberculosis Education/Counseling Record
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-202
Tuberculosis Health Assessment/History
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-201
TB Case and Suspect Management Plan for Outpatient Care
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-13458
Report/Request for TB Supplies
Infectious Disease Control Unit - TB - 320
Forms
EF12-12870
Correctional Tuberculosis Program Symptom Screening
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-207
Targeted Tuberculin Testing Screening Form
Infectious Disease Control Unit - TB - 320
Electronic File
Posters
Violence / Violencia 1-184P
Clueless About Dating Violence?
Warehouse
E19-11457
Communicable Disease Control Measures in Texas: A Guide for Hlth Authorities in Public Hlth Emerg
Regional & Local Svs - 321 Electronic File
E50-11436
Preparedness Planning Review (Bioterrorism Planning Review Newsletter)
HSR 1 - Public Health Preparedness - 160
Electronic Newsletter/Magazine
50-11436
Preparedness Planning Review (Bioterrorism Planning Review Newsletter)
HSR 1 - Public Health Preparedness - 159
Newsletters
Weight Control / Control de peso obes-portfolio
Texas Obesity Policy Portfolio
Prog Coord, Policy & Innov- 785
Electronic File
ECF-000-09
Watching Your Child's Weight: How do you get your child to eat, but not too much?
Nutrition Services - 384
WIC Lesson/TrainingElectronic
E40464
Building Healthy Families
Communications- 517
Electronic File
13-06-12184
5 Steps to a Healthy Weight (poster)
Posters
13-06-12858
WWW - Walk Circles Around Your Scale (poster) (Restricted to WIC Local Agencies)
Posters
E108-12871
Farm to Work Toolkit
Nutrition/Physical Activity/Obesity Prevent 738
Electronic File
West Nile Virus / Virus del Nilo Occidental WN-Fact-Clin
West Nile Virus Fact Sheet for Clinicians
Zoonosis - 428
Electronic File
WN-Fact-Phys
West Nile Virus Fact Sheet for Physicians
Zoonosis - 428
Electronic File
WN-Fact-Camp
West Nile Virus Fact Sheet for Campers
Zoonosis - 428
Electronic File
EF15-11878
Mosquito-borne Illness Case Investigation Form
Zoonosis - 448
Electronic File
E19-11724
Defend Yourself Against West Nile Virus
Infectious Disease - 381
Electronic File
E19-11721
West Nile Virus Education Packet (Information about West Nile Virus)
Infectious Disease - 381
Electronic File
WN-Fact-Vet
West Nile Virus Fact Sheet for Veterinarians
Zoonosis - 428
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 156 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Women - Health & Hygiene / Mujeres--salud e higiene E10-77
Nobody Said You Had to Act Your Age
Osteoporosis - 225
Electronic File
E10-76
Remember When Your Mother Used to Say "Just Drink This--It's Good For You?" (Asian women)
Osteoporosis - 225
Electronic File
E10-15K
ABCs of Health - Stress
Adult Health - 231
Electronic File
E10-75
Congratulations, Your Life Is About to Change for the Better (African American women)
Osteoporosis - 225
Electronic File
E10-74
Life Lessons: Smart Thinking for Today's Women
Osteoporosis - 225
Electronic File
E10-73
Wisdom: Sharing the Secrets of Long Life with Asian Women
Osteoporosis - 225
Electronic File
E10-72
The Secret of Maria's New Life
Osteoporosis - 225
Electronic File
E10-71
Backbone: In Support of African American Women
Osteoporosis - 225
Electronic File
E10-70
Step By Step: Supporting Hispanic Women's Health at Every Stage of Life
Osteoporosis - 225
Electronic File
1-184P
Clueless About Dating Violence?
Warehouse
Posters
E10-66
Breast and Cervical Cancer Services (BCCS) Brochure
Breast & Cervical Cancer 749
Electronic File
E10-15B
ABCs of Health - Breast Examination and Mammogram/Pap Test
Adult Health - 231
Electronic File
E04-10279
The Commitment
Breast & Cervical Cancer - 374
Electronic Newsletter/Magazine
25TAC601.8(1)
Disclosure and Consent for Hysterectomy
Health Facility Licensing 339
Forms
13-06-12365-2
Child's Play Bulletin Board Exercise Helps Children To:
1-185P
Guys, Do You Know How to Treat Your Date or Girlfriend Right?
Perinatal/Maternal/Child 76
Posters
E13-13496
Black Women and HIV in Northeast Texas
HIV/STD - 886
Electronic File
E10-66A
Cancer de mama y de cuello de utero servicios folleto (Breast/Cervical Cancer Services brochure
Breast & Cervical Cancer 749
Electronic File
E1-451
A Woman's Right To Know Resource Directory
Perinatal/Maternal/Child 455
Electronic File
EF05-12532
Women's Health Program Screening Form
Preventive & Primary Care - 678
Electronic File
E50-10873
Literature Review - Women's Health/Children's Health
HSR 1 - 394
Electronic File
E44-10946
Your Life is About to Change for the Better (general audiences)
Osteoporosis - 225
Electronic File
E13-13494
Black Women and HIV in Fort Worth
HIV/STD - 886
Electronic File
E13-06-10411
Folic Acid and Women of Childbearing Age, No. 17
Nutrition Services - 199
Electronic File
E44-10831
1998-99 Biennial Report of the Osteoporosis Advisory Committee
Osteoporosis - 225
Electronic File
EWHR-1
Education/Counseling Record
Perinatal/Maternal/Child 446
Electronic File
EWHR-4
Pregnancy Test
Perinatal/Maternal/Child 446
Electronic File
E44-10937
Osteoporosis Resource Guide
Osteoporosis - 225
Electronic File
EWHR-6
Provider Signature Sheet
Perinatal/Maternal/Child 446
Electronic File
E1-450
A Woman's Right to Know
Perinatal/Maternal/Child 455
Electronic File
E13-13491
Black Women and HIV in the Golden Triangle
HIV/STD - 886
Electronic File
E13-13504
Black Women and HIV in Texas
HIV/STD - 886
Electronic File
EWHR-IN
Women's Health Record Instructions
Perinatal/Maternal/Child 446
Electronic File
Stock #4-25-lang Revised 10/25/2010
Bulletin Board
Page 157 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E13-13498
Black Women and HIV in TDCJ
HIV/STD - 886
Electronic File
E13-13497
Black Women and HIV in San Antonio
HIV/STD - 886
Electronic File
E13-13495
Black Women and HIV in Houston
HIV/STD - 886
Electronic File
E13-13493
Black Women and HIV in Dallas
HIV/STD - 886
Electronic File
EWHR-8
Headache Evaluation
Perinatal/Maternal/Child 446
Electronic File
E25TAC601.8(1)
Disclosure and Consent for Hysterectomy
Health Facility Licensing 635
Electronic File
E13-11919
Yeast (Thrush) Fact Sheet
HIV/STD - 449
Fact Sheets
E13-11917
Vaginitis Fact Sheet
HIV/STD - 449
Fact Sheets
Pelvic Inflammatory Disease (PID) Fact Sheet
HIV/STD - 449
Fact Sheets
E13-11909
Women, Infants, & Children Program / Programa de Nutricion Suplementaria para Mujeres, Bebes y Ninos 13-06-12348
WWW - WIC Works Wellness (small wallet card) (Restricted to WIC local agencies)
Small card
13-06-12365
Child's Play Bulletin Board Cover Sheet
Bulletin Board
13-06-12365-1
Child's Play Bulletin Board Title Piece
Bulletin Board
13-06-12365-11
Child's Play Staff Survey
Bulletin Board
13-06-12365-12
Child's Play Participant Survey
Bulletin Board
13-06-12365-10
Child's Play Sample Layout
Bulletin Board
13-06-12287
Breastmilk: 100% Natural Ingredients (Bib) (restricted to WIC Local Agencies)
Infant Bib
13-06-12286
Breastmilk: 100% Natural Ingredients (Bag) (restricted to WIC Local Agencies)
Bag
13-06-12262
Hey Look What I can Do (poster)
Posters
13-06-12233
How to tell if your newborn is getting enough breastfmilk (Restricted to WIC Local Agencies)
Magnets
13-06-12076
As a Doctor, I Support Breastfeeding (poster)
Posters
13-06-12075
Act Natural..Breastfeed (poster)
Posters
13-06-11934
I'm A Proud Dad (poster)
Posters
13-06-11929
WIC Training Catalog (Restricted to WIC local agencies)
Catalogs
13-06-11178
Texas Ten Step Hospitals (Restricted to WIC local agencies)
Posters
06-10664
Texas WIC News
Newsletters
13-06-12184
5 Steps to a Healthy Weight (poster)
Posters
WIC-32
Applicant's Statement of Farm/Self-Employment
Nutrition Services - 885
E13-06-12038
How Do I Know if I am Making Enough Milk?
Nutrition Services - 570
Electronic File
E13-167
Lactation Support Directory (Lactation Support Resource Directory)
Nutrition Services - 506
Electronic File
E13-179
Breastfeeding in Public
Nutrition Services - 809
Electronic File
E13-185
Physician's Pocket Guide to Breastfeeding
Nutrition Services - 506
Electronic File
E13-206
Hand Expression and Storage of Breastmilk
Nutrition Services - 809
Electronic File
E13-27-1
Breastfeeding Promotion and Support Module Training Guide Workbook
Nutrition Services - 205
Electronic File
E13-140
WIC Breastfeeding Peer Counselor Training Manual - For the Instructor
Nutrition Services - 150
Electronic File
E13-46
Mother's Milk For Premature Babies
Nutrition Services - 570
Electronic File
E13-101
Family Planning and Breastfeeding
Nutrition Services - 809
Electronic File
Stock #4-25-lang Revised 10/25/2010
Forms
Page 158 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
WIC-19B
WIC Employment Verification Form
Nutrition Services - 885
Forms
E4-20-10
Women, Infants, Children Audiovisual Catalog
Audiovisual Library - 196
Electronic File
EBF-000-08
Benefits of Breastfeeding
Nutrition Services - 412
WIC Lesson/TrainingElectronic
EBF-000-09
Giving You the Best That I Got, Baby
Nutrition Services - 412
WIC Lesson/TrainingElectronic
F13-06-13184
Texas Ten Step Applications
Forms
F13-06-13152
Texas WIC Medical Request for Formula/Food
Forms
F13-06-13104A
Como puedo saber si va bien la lactancia materna (How Do I Know Breastfeeding Is Going Well?)
Forms
E13-33
Basic Nutrition Module
Nutrition Services - 205
Electronic File
E13-06-13124
WIC Food Packages for Moms and Infants
Nutrition Services - 809
Electronic File
E13-06-12076
As a Doctor, I Support Breastfeeding (poster)
Nutrition Services - 570
Electronic File
E13-06-12077
Doctors Make the Difference, Incorporating Breastfeeding into Prenatal Care
Nutrition Services - 506
Electronic File
E13-06-12079
Your Baby, Your Gift
Nutrition Services - 809
Electronic File
E13-06-12080
Support Your Daughter
Nutrition Services - 570
Electronic File
E13-06-12081
Support Your Partner
Nutrition Services - 570
Electronic File
E13-06-12114
Steps to a Breastfeeding-Friendly Practice
Nutrition Services - 506
Electronic File
E13-159
Texas Position Statement on Infant Feeding
Nutrition Services - 506
Electronic File
E13-06-13120
The Hospital Experience: What to Expect and How to Make it Memorable
Nutrition Services - 809
Electronic File Forms
F13-06-13103
Breast Pumping Log
E13-06-13180
WIC Breastfeeding Peer Counselors: The Support Your Patients Need for Breastfeeding Success
Nutrition Services - 809
Electronic File
E13-06-13181
Become a WIC Breastfeeding Peer Counselor
Nutrition Services - 809
Electronic File
E13-06-13182
WIC Peer Counselors: The Support You Need to Successfully Breastfeed
Nutrition Services - 809
Electronic File
E13-06-13183
Breastfeeding: The Best Medicine You Can Prescribe
Nutrition Services - 804
Electronic File
E13-06-13331
Breastfeeding Beyond Six Months?
Nutrition Services - 809
Electronic File
E13-06-13430
It's Your Job. Protecting the Civil Rights of our Participants
Nutrition Services - 871
Electronic File
WIC-35
Family Certification Form (Replaced WIC-19)
Nutrition Services - 885
Forms
E13-06-12554
Community Action Kit for Protecting, Promoting, and Supporting Breastfeeding
Nutrition Services - 684
Electronic File
EWIC-34-7
Texas WIC Shopping Guide for Kosher Milk and Cheese
Nutrition Services - 418
Electronic File
EWIC-38
Child Participant Form (Replaced WIC-11)
Nutrition Services - 730
Electronic File
EWIC-36
Infant Participant Form (Replaced WIC-11)
Nutrition Services - 730
Electronic File
EGN-000-07
Small Changes, Big Difference
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EWIC-35-3
WIC Income Questionnaire
Nutrition Services - 401
Electronic File
EWIC-35-1
WIC Supplemental Information Form
Nutrition Services - 401
Electronic File
EGN-000-10
Food Demonstrations: Orange Froth and Frozen Chocolate Banana
Nutrition Services - 414
WIC Lesson/TrainingElectronic
ECF-000-09
Watching Your Child's Weight: How do you get your child to eat, but not too much?
Nutrition Services - 384
WIC Lesson/TrainingElectronic
EWIC-35
Family Certification Form (Replaced WIC-19)
Nutrition Services - 401
Electronic File
EWIC-41
Postpartum Participant Form (Replaced WIC-11)
Nutrition Services - 730
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 159 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EWIC-34-3
Shopping Guide for Fruits and Vegetables
Nutrition Services - 824
Electronic File
EWIC-34-2
Shopping Guide for Exclusively Breastfed Infants
Nutrition Services - 824
Electronic File
EGN-000-19
Let's get cooking with Fruits
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EGN-000-20
Let's get cooking with Vegetables
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EIF-000-09
Infant Feeding Bingo
Nutrition Services - 416
WIC Lesson/TrainingElectronic
E13-27-3
Breastfeeding Promotion and Support Module- Part 3: Answer Key
Nutrition Services - 205
Electronic File
13-06-12365-13
Child's Play Client Questionnaire
EGN-000-11
Quick and Easy Vitamin A
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EF13-06-13101
Breastfeeding Follow-up Form
Nutrition Services - 809
Electronic File
E13-06-12010
Food Safety During Pregnancy
Nutrition Services - 199
Electronic File
Bulletin Board
F13-06-13102
Breastfeeding Assessment and Counseling Form
Forms
F13-06-13101
Breastfeeding Follow-up Form
Forms
F13-06-12805
VENA Family Documentation Form (restricted to Texas WIC Local Agencies)
Forms
F13-06-11521
WIC Self-Declaration Form for Ident, Residency, Zero-Income/Proof of Income (Homeless)Restricted
Forms
EWIC-54EBT
Donated Formula Blank Log (WIC) (Restricted to WIC Local Agencies)
Nutrition Services - 669
Electronic File
EWIC-45
Diet History for Pregnant/Breastfeeding/Postpartum Women
Nutrition Services - 730
Electronic File
EWIC-39
Pregnant Women Participant (Replaced WIC-11)
Nutrition Services - 730
Electronic File
EF13-06-12805
VENA Family Documentation Form (restricted to Texas WIC Local Agencies)
Nutrition Services - 730
Electronic File
EWIC-40
Breastfeeding Participant Form (Replaced WIC-11)
Nutrition Services - 730
Electronic File
EF13-06-13134
EBT Client Dispute Form
Nutrition Services - 803
Electronic File
EF13-06-13152
Texas WIC Medical Request for Formula/Food
Nutrition Services - 669
Electronic File
EF13-06-13158
Texas WIC Metabolic Request for Formula/Food
Nutrition Services - 669
Electronic File
EF13-06-13184
Texas Ten Step Applications
Nutrition Services - 809
Electronic File
EWIC-42
Health History for Infants
Nutrition Services - 730
Electronic File
EFG-000-04
5-a-day Bingo
Nutrition Services - 643
WIC Lesson/TrainingElectronic
F13-06-13104
How Do I Know Breastfeeding Is Going Well?
EWIC-44
Health History for Children
13-06-12408-3
Breastfeeding is Healthy for Mothers (Restricted to WIC Local agencies)
Bulletin Board
13-06-12408-7
Picture of baby breastfeeding (Restricted to WIC Local agencies)
Bulletin Board
Forms Nutrition Services - 730
Electronic File
WIC-54EBT
Donated Formula Log EBT Form (Restricted to WIC Local Agencies)
Forms
WIC-53EBT
Sample Formula Log EBT Form (restricted to WIC Local Agencies)
Forms
WIC-52EBT
Returned Formula Log EBT Form (Restricted to WIC Local Agencies)
Forms
WIC-4-1
Prenatal Weight Gain Grid Multi
13-06-12408-12
Get Breastfeeding Off to a Good Start (handout/questionnaire) (Restricted to WIC Local agencies)
Bulletin Board
13-06-12408-2
Breastmilk is easier for your baby to digest (Restricted to WIC Local agencies)
Bulletin Board
Stock #4-25-lang Revised 10/25/2010
Nutrition Services - 885
Forms
Page 160 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Bulletin Board
13-06-12408-10
Breastfeeding-because your baby deserves the very best (staff survey) (limited distribution)
WIC-40
Breastfeeding Participant Form (Replaced WIC-11) (restricted to Texas WIC Local Agencies)
13-06-12408-1
Breastfeeding-because your baby deserves the very best (Title Piece) (limited distribution)
Bulletin Board
13-06-12408-4
Planning to Return to Work or School? (Restricted to WIC Local agencies)
Bulletin Board
13-06-12408-5
Breastfeeding is Convenient (Restricted to WIC Local Agencies)
Bulletin Board
WIC-4
Range of Prenatal Weight Gain
Nutrition Services - 885
Forms
WIC-39
Pregnant Women Participant (Replaced WIC-11) (restricted to Texas WIC Local Agencies)
Nutrition Services - 885
Forms
WIC-38
Child Participant Form (Replaced WIC-11) (restricted to Texas WIC Local Agencies)
Nutrition Services - 885
Forms
WIC-37
Quick Intake/In-State Transfer Form
Nutrition Services - 885
Forms
E13-06-12075
Act Natural..Breastfeed (poster)
Nutrition Services - 570
Electronic File
WIC-41
Postpartum Participant Form (Replaced WIC-11) (restricted to Texas WIC Local Agencies)
Nutrition Services - 885
Forms
13-06-12366-3
Child's Play Borders (horizontal, left side two girls holding hands and running)
Bulletin Board
13-06-12365-4
Child's Play Bulletin Board pieces Boy on slide with parents on each side picture
Bulletin Board
13-06-12365-5
Child's Play Bulletin Board pieces Boy playing soccer picture
Bulletin Board
Nutrition Services - 885
Forms
13-06-12365-6
Child's Play Bulletin Board pieces - Baby with Toys picture
Bulletin Board
13-06-12365-7
Child's Play Bulletin Board pieces Girl with Father on jungle gym picture
Bulletin Board
13-06-12365-8
Child's Play Bulletin Board pieces Parents with twins picture
Bulletin Board
13-06-12365-9
Child's Play Bulletin Board pieces Boys on teeter-totter picture
Bulletin Board
13-06-12366
Child's Play Borders (horizontal-left side Boy on Bike)
Bulletin Board
13-06-12408-11
Breastfeeding Lesson Survey Form - Participant (Restricted to WIC Local agencies)
Bulletin Board
13-06-12366-2
Child's Play Borders (horizontal-left side two girls skipping)
Bulletin Board Nutrition Services - 885
Forms
WIC-35-1
WIC Supplemental Information Form
13-06-12366-4
Child's Play Borders (horizontal-left side two children w Butterfly net, right side girl faces left)
Bulletin Board
13-06-12366-5
Child's Play Borders (horizontal, left side girl with ball)
Bulletin Board
13-06-12366-6
Child's Play Borders (vertical, Mom with child faces left)
Bulletin Board
13-06-12366-7
Child's Play Borders (vertical, girl with ball faces left)
Bulletin Board
13-06-12366-8
Child's Play Borders (vertical, Mom with child faces right)
Bulletin Board
13-06-12366-9
Child's Play Borders (vertical, girl with ball faces right)
Bulletin Board
13-06-12408
Breastfeeding-because your baby deserves the very best (cover sheet) (Restricted distribution)
Bulletin Board
13-06-12366-1
Child's Play Borders (horizontal-left side two children w Butterfly net, right side girl faces right
Bulletin Board
E06-10659
Special Supplemental Nutrition Program for Women, Infants, & Children (WIC) State Plan
13-163
Just Take One
WIC-36
Infant Participant Form (Replaced WIC-11)(restricted to Texas WIC Local Agencies)
Nutrition Services - 885
Forms
13-25
Girl Crib Card
Nutrition Services - 885
Small card
Stock #4-25-lang Revised 10/25/2010
Nutrition Services - 224
Electronic File Posters
Page 161 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
13-25-1
Boy Crib Card
Nutrition Services - 885
Small card
13-25-2
Girl NICU Crib Card
Nutrition Services - 885
Small card
13-25-3
Boy NICU Crib Card
Nutrition Services - 885
Small card
E13-06-11934
I'm A Proud Dad (poster)
Nutrition Services - 570
Electronic File
13-7
We Are Here to Serve You
Nutrition Services - 885
Posters
13-06-13404
Breastfeeding-Friendly Establishment (window clings) (restricted to WIC Local Agencies)
E06-10660
WIC Policies and Procedures Manual
Nutrition Services - 102
Electronic File
E06-10664
Texas WIC News
Nutrition Services - 444
Electronic Newsletter/Magazine
E06-11170
Farmers' Market Nutrition Program
Nutrition Services - 224
Electronic File
E13-06-10830
License to Breastfeed in Public Card
Nutrition Services - 570
Electronic File
E13-06-11056
Texas Nutrition Risk Manual
Nutrition Services - 73
Electronic File
E13-06-11288
Just For Grandparents
Nutrition Services - 809
Electronic File
E13-06-11342
WIC Breastfeeding Peer Counselor Training Manual - For the Counselor
Nutrition Services - 150
Electronic File
13-37-1
Infant Nutrition Module Answer Key (WIC)
WIC Lessons/Training
13-06-12409-5
Breastfeeding-because your baby deserves the very best (verticalrattle/duck) (limited distribut)
Bulletin Board
13-06-12408-8
Picture of mother and baby looking at each other while breasfeeding (Limited to WIC Local agencies)
Bulletin Board
13-06-12408-9
Breastfeeding-because your baby deserves the very best (sample layout) (limited distribution)
Bulletin Board
13-06-12409
Breastfeeding-because your baby deserves the very best (borders) (Restricted distribution)
Bulletin Board
13-06-12409-1
Breastfeeding-because your baby deserves the very best (horiz borderpacifier) (limited distribut)
Bulletin Board
13-06-12409-2
Breastfeeding-because your baby deserves the very best (horiz borderbear) (Restricted distribut)
Bulletin Board
13-186
Ask about our WIC Breast Pump Program (Poster)
Posters
13-06-12409-4
Breastfeeding-because your baby deserves the very best (verticalshoes/bear) (limited distribut)
Bulletin Board
13-06-13393
Breastfeeding Logo (stickers)
Stickers
13-06-12409-6
Breastfeeding-because your baby deserves the very best (verticalbutterfly/bear) (limited distribut)
Bulletin Board
13-06-12409-7
Breastfeeding-because your baby deserves the very best (verticalbutterfly/duck) (limited distribut)
Bulletin Board
13-06-12543
WWW - Highway to Health (map) (restricted to WIC local agencies)
Maps
13-06-12579
Zobey Magnet: Did You Know that Children Need (Restricted to WIC local agencies)
Magnets
13-06-12858
WWW - Walk Circles Around Your Scale (poster) (Restricted to WIC Local Agencies)
Posters
13-06-12928
WWW - Color Your Way (poster) (Restricted to WIC local agencies)
Posters
13-06-13075
WWW - Park It Here (Poster) (Restricted to WIC local agencies)
Posters
Window clings
13-06-13082
What Interests You? (poster)
Posters
13-06-12409-3
Breastfeeding-because your baby deserves the very best (horiz bordershoes) (limited distribut)
Bulletin Board
Zoonoses / Zoonosis EF15-11922
Plague Case Investigation
Stock #4-25-lang Revised 10/25/2010
Zoonosis - 448
Forms
Page 162 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E7-24
Rocky Mountain Spotted Fever
Zoonosis - 376
Electronic File
zooform
Report of Zoonotic Disease in Animals
Zoonosis - 633
Electronic File
EF15-11882
Tularemia Case Investigation Form
Zoonosis - 448
Electronic File
E7-7
Encephalitis
Zoonosis - 376
Electronic File
E7-16
The Wild Side of Rabies
Zoonosis - 376
Electronic File
E7-18
Rabies Control Act (Chapter 826 Texas Health & Safety Code)
Zoonosis - 105
Electronic File
E7-19
Rules of the Board of Health (Chapter 826-Rabies Control and Eradication)
Zoonosis - 105
Electronic File
E7-20
Animal Bites
Zoonosis - 376
Electronic File
E7-22
Wildlife as Pets
Zoonosis - 376
Electronic File
E7-14
Facts about Rabies
Zoonosis - 376
Electronic File
E7-25
Rabies and Wildlife (poster)
Zoonosis - 376
Electronic File
E7-12
Organizing a Low-Cost Rabies Vaccination Clinic Pamphlet
Zoonosis - 376
Electronic File
E7-32
Murine Typhus (Fleaborne typhus)
Zoonosis - 376
Electronic File
E7-34
Toxoplasmosis
Zoonosis - 376
Electronic File
E7-35
Lyme Disease
Zoonosis - 376
Electronic File
E7-36
Facts About Plague
Zoonosis - 376
Electronic File
E7-37
Hantavirus Pulmonary Syndrome
Zoonosis - 376
Electronic File
E7-39
Bats and Rabies Poster for Schools
Zoonosis - 376
Electronic File
E7-27
Zoonoses
Zoonosis - 376
Electronic File
E19-11724
Defend Yourself Against West Nile Virus
Infectious Disease - 381
Electronic File
53-10879
Quarterly Zoo Crew Dispatch
HSR 6/5S-Zoonosis Control - 143
Newsletters
56-12399
Zoonosis News from Health Service Region 9/10
HSR 9/10 -Zoonosis- 618
Newsletters
57-10768
Region 11 Zoonosis Control Monthly Newsletter
Region 11 - Zoonosis Control - 108
Newsletters
7-21
Preventing Dog Bites to Infants
Warehouse
Posters
7-25
Rabies and Wildlife (poster)
Warehouse
Posters
7-26
Rabies Poster (Protect Your Pets and Yourself Against Rabies! Vaccinate Your Pets)
Warehouse
Posters
E7-15
Rabies-and How It Can Be Controlled
Zoonosis - 376
Electronic File
7-39
Bats and Rabies Poster for Schools
Warehouse
Posters
E7-28
Caring for Your Pet
Zoonosis - 376
Electronic File
E2-8
Bats
Zoonosis - 538
Electronic File
E50-10970
Zoonosis News from Health Service Region 1
HSR 1-Zoonosis - 604
Electronic Newsletter/Magazine
E53-10879
Quarterly Zoo Crew Dispatch
HSR 6/5S-Zoonosis Control - 156
Electronic Newsletter/Magazine
E57-10768
Region 11 Zoonosis Control Monthly Newsletter
Region 11 - Zoonosis Control - 547
Electronic Newsletter/Magazine
E6-33
A Guide to the Diagnosis of Tick-Borne Diseases
Zoonosis - 376
Electronic File
E7-11
Oral Rabies Vaccination Program
Zoonosis - 376
Electronic File
7-38
Plague Warning (poster)
Warehouse
Posters
EF15-11878
Mosquito-borne Illness Case Investigation Form
Zoonosis - 448
Electronic File
EF15-11881
Rickettsial Disease Case Investigation Form
Zoonosis - 448
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 163 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF15-11879
Q-Fever Case Investigation Form
Zoonosis - 448
Electronic File
EF15-11880
Tick-borne Relapsing Fever Case Investigation Form
Zoonosis - 448
Electronic File
EF15-11877
Lyme Disease Case Investigation Form
Zoonosis - 448
Electronic File
EF15-11875
Anthrax Case Investigation Form
Zoonosis - 448
Electronic File
EF15-11876
Brucellosis Case Investigation Form
Zoonosis - 448
Electronic File
Warehouse
Directories
Vital Statistics - 346
Electronic File
English/Spanish Abortion / Aborto 1-451
A Woman's Right to Know Resource Directory / Directorio de Recursos (Limit 100)
Adoption / Adopcion EVS-2271
Texas Voluntary Adoption Registry Registration Application (Central Adoption Registry Application)
Brain Injury / Lesion cerebral E4-81
Concussion: Signs and Symptoms of a Brain Injury Card (White) Adult version/Concusiones-signos y
EMS - 328
Electronic File
E4-80
Concussion in Children: Signs and Symptoms of Brain Injury (Yellow)/Las concusiones en los ninos
EMS - 328
Electronic File
E6-80
Concussion Card/Child/Open Provider (yellow)/Las concusiones en los ninos
Epidemiology/Injury Surveillance - 351
Electronic File
E6-81
Concussion Card/Adult/Open Provider/Concusiones-signos y sintomas de una lesion cerebral
Epidemiology/Injury Surveillance - 351
Electronic File
Breastfeeding / Alimentacion con pecho EF13-06-13185
Request for Breast Pump Assistance from the Texas WIC Program
Nutrition Services - 820
Electronic File
ECH-000-14
Something Good for Babies / Algo bueno por los bebes
Nutrition Services - 383
WIC Lesson/TrainingElectronic
EBF-000-29
Breastfeeding and Returning to Work/La alimentacion con pecho y el regreso al trabajo
Nutrition Services - 412
WIC Lesson/TrainingElectronic
EBF-000-28
Breastfeeding Rummy / Juego de Rummy de la alimentacion con pecho
Nutrition Services - 412
WIC Lesson/TrainingElectronic
E13-06-12031
Breastfeeding Support Pledge Card (WIC) / Tarjeta de apoyo para alimentar con pecho
Nutrition Services - 570
Electronic File
13-06-13394
Breastmilk: Every Ounce Counts (Baby) (Poster)
13-06-12831
Breastfeeding Welcome Here / Aqui se permite amamantar (decal)
Posters Decal Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-06
A Helping Hand for Breastfeeding Moms/Una mano de ayuda para las mamas que estan alimentando
13-16
Mother's Milk: Baby's First Immunization / La leche materna: La primer vacuna para su bebe
EBF-000-27
Breast is Best:Scientifically Proven Benefits of Breastfeeding/La alimentacion con el pecho es mejor
Nutrition Services - 412
WIC Lesson/TrainingElectronic
EBF-000-31
To Baby with Love: Overcoming Breastfeeding Barriers/Para me bebe con amor: superando las barreras
Nutrition Services - 412
WIC Lesson/TrainingElectronic
E13-06-11549
Colostrum (Mother's First Breastmilk) / El calostro (La primera leche materna)
Nutrition Services - 809
Electronic File
EBF-000-33
A Mother's Gift / El regalo de una madre
Nutrition Services - 412
WIC Lesson/TrainingElectronic
ECH-000-19
Let's Read "We Like to Nurse" / Nos gusta amamantar
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ECH-000-18
Let's Read "Breastfeeding Makes my Tummy Yummy" by Ceclia Moen
Nutrition Services - 383
WIC Lesson/TrainingElectronic
Stock #4-25-lang Revised 10/25/2010
Posters
Page 164 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
EBF-000-32
How to Get Breastfeeding off to a Good Start/Como empezar la alimentacion con pecho correctamente
Nutrition Services - 412
WIC Lesson/TrainingElectronic
ECH-000-15
Mammal-Baby Bingo
Nutrition Services - 383
WIC Lesson/TrainingElectronic
EPB-000-06
Breastfeeding-because your baby deserves the very best / Alimento con pecho
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EBF-000-12
Infant Feeding Cues / Las senales de hambre en los recien nacidos
Nutrition Services - 412
WIC Lesson/TrainingElectronic
EWIC-34-6
Texas WIC Shopping Guide for Exclusively Breastfeeding Women
Nutrition Services - 824
Electronic File
ESP-000-25
The Comfortable Latch Self-Paced Lesson / El agarre mas comodo (Restricted to WIC local agencies)
Nutrition Services - 420
WIC Lesson/TrainingElectronic
E13-133
Dad's Role in Supporting Breastfeeding / El rol del papa en el apoyo de la lactancia
Nutrition Services - 809
Electronic File
E13-16
Mother's Milk: Baby's First Immunization / La leche materna: La primer vacuna para su bebe
Nutrition Services - 570
Electronic File
ESP-000-24
To Baby With Love: Overcoming Breastfeeding Barriers/Para el bebe con amor
Nutrition Services - 420
WIC Lesson/TrainingElectronic
13-06-12408-6
Handouts and Client Questionnaire/ Hojas de informacion y cuestionario para clientes (limited distri
EBF-000-30
Breastfeed: That's the Ticket / Alimentacion con pecho: asi se debe de hacer
Nutrition Services - 412
WIC Lesson/TrainingElectronic
E13-162
Breastfeeding Facts / Informacion sobre la lactancia materna (Restricted to WIC local agencies)
Nutrition Services - 809
Electronic File
EBF-000-23
A Mother's Guide to Breastfeeding / Guia materna para la alimentacion con el pecho
Nutrition Services - 412
WIC Lesson/TrainingElectronic
ESP-000-14
How Will You Feed Your New Baby?/Como alimentara usted a su nuevo bebe?
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EBF-000-13
Helping Hand for Breastfeeding Moms / Mano de ayuda
Nutrition Services - 412
WIC Lesson/TrainingElectronic
EBF-000-18
The Best Thing / Es lo Mejor
Nutrition Services - 412
WIC Lesson/TrainingElectronic
ESP-000-07
How to Breastfeed Your Newborn / Como alimentar a su recien nacido
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-11
Weaning Your Baby From the Breast/Como dejar de alimentar con el pecho a su bebe
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EBF-000-14
The Best Investment / La mejor inversion
Nutrition Services - 412
WIC Lesson/TrainingElectronic
ESP-000-08
Breastfeed Twins, Triplets or More / Alimentando con el pecho a gemelos, trillizos o mas?
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EBF-000-15
Teen Breastfeeding - Why Breastfeed? / Por que alimentar con el pecho?
Nutrition Services - 412
WIC Lesson/TrainingElectronic
Bulletin Board
Cancer / Cancer E10-64
Breast and Cervical Cancer Services poster/Cancer de mama y de cuello de utero servicios cartel
Breast & Cervical Cancer 749
Electronic File
E10-62
Breast and Cervical Cancer Services flyer/Cancer de mama y de cuello de utero servicios flyer
Breast & Cervical Cancer 749
Electronic File
Case Management / Administracion de casos CPW-13E-S
Case Management Client Satisfaction Survey / Encuesta de Opinion del Cliente
Case Management - 309
Electronic File
CPW-08E-S
Case Management Case Closure Form / Documento para cerrar los casos
Case Management - 309
Electronic File
CPW-03Signature
Case Management Service Plan Signature Page/Plan de Servicios
Case Management - 309
Electronic File
CPW-07E-S
Case Management Referral Form / Formulario de recomendacion del caso
Case Management - 309
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 165 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
CPW-03E-S
Case Management Service Plan/Plan de Servicios
Case Management - 309
Electronic File
CPW-09E-S
Case Management Case Transfer / Documento para transferir los casos
Case Management - 309
Electronic File
Child Development / Desarrollo infantil EGD-000-04
Welcome to the Zowzoo Take Home Class/Bienvenido a la clase de Zowzoo
Nutrition Services - 415
WIC Lesson/TrainingElectronic
EGD-000-08
The Adventures of Zobey: A Trip to Bugland (group)/ Las Aventuras de Zobey: un viaje a insectolandia
Nutrition Services - 415
WIC Lesson/TrainingElectronic
ESP-000-29
The Adventures of Zobey: A Trip to Bugland (home)/ Las Aventuras de Zobey: un viaje a insectolandia
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-23
Cut Back on Screen Time/Acorte el tiempo frente a la pantalla
Nutrition Services - 420
WIC Lesson/TrainingElectronic
Children - Care & Hygiene / Ninos--su cuidado e higiene personal E05-12869
Head Lice Fact Sheet #6: Head Lice Resources / Recursos sobre los piojos de la cabeza
School Health Program 685
Electronic File
E1-187
Welcome to Texas Health Steps Medicaid / Bienvenido a Medicaid de Pasos Sanos de Tejas!
Texas Health Steps - 284
Electronic File
E1-17
Helpful Hints for Healthy Hearing / Consejos Utiles para una Audicion Sana
Vision, Hearing and Spinal Screening - 372
Electronic File
E11-12812
Influenza (Flu) Fact Sheet for Child-Care Settings / Influenza (La gripe): hoja de informes para gua
Immunization - 781
Electronic File
E08-13375
Texas Health Steps Checkups-Keeping Your Child Healthy / Los examenes de Pasos Sanos de Tejas
Texas Health Steps - 24
Electronic File
ET-3
Children with Special Health Care Needs Application Book/Folleto de solicitud
Children w/Special Health Care Needs - 692
Electronic File
ESP-000-15
Your Baby's Beautiful Teeth/Los hermosos dientes de su bebe
Nutrition Services - 420
WIC Lesson/TrainingElectronic
E05-12865
Head Lice Fact Sheet #2: How do I know if my child has head lice / Como se si mi hijo tiene piojos
School Health Program 685
Electronic File
E05-12866
Head Lice Fact Sheet #3: What Should I do if I think my child has head lice? / Que debo hacer si
School Health Program 685
Electronic File
E05-12868
Head Lice Fact Sheet #5: Myths, misconceptions, and truths about head lice treatments / Mitos, ideas
School Health Program 685
Electronic File
T-3
Children with Special Health Care Needs Application Book/Folleto de solicitud (Limit 25)
Warehouse
Forms
13-06-12261
Play with me (poster)
E05-12867
Head Lice Fact Sheet #4: How do I keep lice from coming back? / Como evito que vuelvan los piojos?
School Health Program 685
Electronic File
E05-12864
Head Lice Fact Sheet #1: What are Lice? / Que son los Piojos?
School Health Program 685
Electronic File
E1-29
Everything you need to know about Head Lice / Todo lo que debe saber sobre los piojos
School Health Program 685
Electronic File
E59-11766
Information on Staphylococcal Infections for Day Care Facilities: for Parents
Infectious Disease - 400
Electronic File
EF05-12234
Hearing Checklist for Parents/Lista de comprobacion de audicion para los padres
PACT-Health Steps - 543
Electronic File
EPSDT-05
Checkups and a Whole Lot More / Chequeos-Y mucho, pero mucho mas!
Texas Health Steps - 24
Electronic File
EPSDT-08
THSteps Wallet Cards
Texas Health Steps - 24
Electronic File
E1-188
Introduction to Health Care Orientation / Orientacion a la Atencion Medica
Texas Health Steps - 284
Electronic File
EPSDT-04
Telling Clients About THSteps Desk Reference
Texas Health Steps - 24
Electronic File
Stock #4-25-lang Revised 10/25/2010
Posters
Page 166 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Children - Nutrition / Ninos--su nutricion ECF-000-06
Smart Snacking for Children / Bocadillos con estilo para ninos
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ERB-000-14
Feed Your Child's Future / Alimente el futuro de su nino
Nutrition Services - 419
WIC Lesson/TrainingElectronic
ECF-000-08
Healthy and Tasty Cooking Demonstration-Family/Demonstracion de como cocinar platillos saludables
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECF-000-17
Feeding Your Child 1-3 Years / Alimentando a su nino a los 1-3 anos
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECF-000-21
Healthy Drinks for Healthy Kids / Bebidas saludables para ninos saludables
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECF-000-18
Breakfast is for Champions / El desayuno es para campeones
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ESP-000-18
Growing up from a Baby to a Toddler/El desarrollo de bebe a nino pequeno
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ECH-000-08
Let's Read "Lunch" / Vamos a leer en casa: "La comida"
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ECF-000-22
Tips for Making Family Life Easier / Consejos para facilitar la vida familiar
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECF-000-19
Bring the Outside In / Traiga el exterior hacia el interior
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ESP-000-19
Introducing Finger Foods/Como empezar a darle a su hijo alimentos que se comen con las manos
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ECF-000-10
Don't Use Food as a Reward or Punishment/No use los alimentos como recompensa o castigo
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECF-000-15
Childhood Obesity - Lily Faces a Problem / La obesidad en los ninos
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECH-000-13
Let's Read "D.W., The Picky Eater"/ Vamos a leer en casa: "D.W. tiene problemas para comer"
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ECH-000-12
Let's Read "Oliver's Vegetables" / Vamos a leer en casa: "Los vegetales de Oliver"
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ECH-000-14
Something Good for Babies / Algo bueno por los bebes
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ECH-000-16
Let's Read "Growing Vegetable Soup"
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ECF-000-11
Grocery Store Tour: Shopping for Healthy Snacks-Kids/Comprando bocadillos saludables para los ninos
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECH-000-11
Let's Read "Tops and Bottoms" / Vamos a leer en casa: "Los de arriba y los de abajo"
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ECH-000-09
Let's Read "Bread, Bread, Bread" / Vamos a leer en casa: "Pan, pan, pan"
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ECH-000-10
Let's Read "Eating the Alphabet, Fruits & Vegetables" / Comiendo el alfabeto: frutas y vegatales
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ESP-000-02
Healthy Choices To Go / Selecciones saludables para llevar
Nutrition Services - 420
WIC Lesson/TrainingElectronic
Children with Special Needs / Programa para ninos con necesidades especiales EF07-12540
Emergency Information Form / Formulario de Informacion para Emergencias
Children w/Special Health Care Needs - 709
Electronic File
F07-12606
Photo Release Form/Declaracion de consentimiento y liberacion de responsabilidad para fotos
Children w/Special Health Care Needs - 681
Forms
E07-12357
Client Handbook Children with Special Health Care Needs/Manual para Clientes Servicios Programa de
Children w/Special Health Care Needs - 698
Electronic File
E4-2
Emergency & Disaster Planning / Planificacion de Emergencias y Desastres
Children w/Special Health Care Needs - 709
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 167 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF07-12585
Application for Insurance Premium Payment Assistance/Solicitud para asistencia con pagos de prima
Children w/Special Health Care Needs - 709
Electronic File
EF07-12595
CSHCN Address Change Form/Formulario para cambio de direccion
Children w/Special Health Care Needs - 692
Electronic File
EF07-12780
Medication Form (CSHCN)/ Control de medicamentos
Children w/Special Health Care Needs - 709
Electronic File
EF07-12827
FSS Provider Application
Children w/Special Health Care Needs - 697
Electronic File
ET-3
Children with Special Health Care Needs Application Book/Folleto de solicitud
Children w/Special Health Care Needs - 692
Electronic File
ET-3-1
CSHCN Services Program Basic Application Form/Solicitud basica para el Programa de Servicios CSHCN
Children w/Special Health Care Needs - 692
Electronic File
ET-3-4
CSHCN Physician/Dentist Assessment Form / Formulario de Evaluacion del Medico/Dentista
Children w/Special Health Care Needs - 697
Electronic File
F07-12540
Emergency Information Form / Formulario de Informacion para Emergencias
Children w/Special Health Care Needs - 681
Forms
E07-12275
Newsletter for Families (Children with Special Health Care NeedsCSHCN)/Boletin para familias
Children w/Special Health Care Needs - 565
Electronic Newsletter/Magazine
F07-12595
CSHCN Address Change Form/Formulario para cambio de direccion
Children w/Special Health Care Needs - 681
Forms
E07-13396
What Clients with Cystic Fibrosis Need to Know / Lo Que los clientes con fibrosis quistica deben
Children w/Special Health Care Needs - 692
Electronic File
F07-12780
Medication Form (CSHCN)/ Control de medicamentos
Children w/Special Health Care Needs - 681
Forms
F07-12827
FSS Provider Application
Children w/Special Health Care Needs - 681
Forms
F07-12828
FSS Provider Short-term Application
Children w/Special Health Care Needs - 681
Forms
F07-12840
School Attendance Verification / Verificacion de asistencia a la escuela
Children w/Special Health Care Needs - 681
Forms
F07-13148
Form to Release CSHCN Services Program Claims History / Formulario para divulgar el historial de
Children w/Special Health Care Needs - 681
Forms
F07-13429
Client Drug Co-Pay Reimbursement Request Form/Solicitud del cliente para el reembolso del copago
Children w/Special Health Care Needs - 681
Forms
T-3
Children with Special Health Care Needs Application Book/Folleto de solicitud (Limit 25)
Warehouse
Forms
T-3-1
CSHCN Services Program Basic Application Form/Solicitud basica para el Programa de Servicios CSHCN
Children w/Special Health Care Needs - 681
Forms
T-3-2
Health Insurance Data Form (CSHCN) / Formulario de datos del seguro medico
Children w/Special Health Care Needs - 681
Forms
T-3-3
Rights and Responsibilities Form (CSHCN) / Formulario de derechos y responsabilidades
Children w/Special Health Care Needs - 681
Forms
T-3-4
CSHCN Physician/Dentist Assessment Form / Formulario de Evaluacion del Medico/Dentista
Children w/Special Health Care Needs - 681
Forms
F07-12585
Application for Insurance Premium Payment Assistance/Solicitud para asistencia con pagos de prima
Children w/Special Health Care Needs - 681
Forms
07-12275
Newsletter for Families (Children with Special Health Care NeedsCSHCN)/Boletin para familias
Children w/Special Health Care Needs - 681
Newsletters
Communicable Diseases / Enfermedades transmisibles E11-13214
Fact Sheet Human Papillomavirus (HPV) / Hoja informativa Virus de papiloma humano (HPV)
Immunization - 293
Electronic File
E11-13218
Fact Sheet Pertussis (Whooping Cough) / Hoja informativa Pertusis (Tos Ferina)
Immunization - 293
Electronic File
E11-13215
Fact Sheet Measles / Hoja informativa Sarampion
Immunization - 293
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 168 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E11-13213
Fact Sheet Herpes Zoster (Shingles) / Hoja informativa Herpes zoster (Culebrilla)
Immunization - 293
Electronic File
E11-13216
Fact Sheet Meningococcal Disease / Hoja informativa Enfermedad meningococica
Immunization - 293
Electronic File
E11-13217
Fact Sheet Mumps / Hoja informativa Paperas
Immunization - 293
Electronic File
E11-13220
Fact Sheet Poliomelitis (Polio) / Hoja informativa Poliomieliis (Polio)
Immunization - 293
Electronic File
E11-13219
Fact Sheet Pneumococcal Disease / Hoja informativa Enfermedad neumococica
Immunization - 293
Electronic File
E11-13212
Fact Sheet Hepatitis B (Hep B) / Hoja informativa Hepatitis B (Hep B)
Immunization - 293
Electronic File
E11-13211
Fact Sheet Hepatitis A (Hep A) / Hoja informativa Hepatitis A (Hep A)
Immunization - 293
Electronic File
E11-13209
Fact Sheet Diphtheria / Hoja informativa Difteria
Immunization - 293
Electronic File
E11-13221
Fact Sheet Rotavirus / Hoja informativa Rotavirus
Immunization - 293
Electronic File
E11-12812
Influenza (Flu) Fact Sheet for Child-Care Settings / Influenza (La gripe): hoja de informes para gua
Immunization - 781
Electronic File
E11-11699P
Anyone Can Get Pertussis / A cualquiera le puede dar la tos ferina
Immunization - 781
Electronic File
E11-11531P
Is it Just a Cough?/Es solamente una tos? (Pertussis Poster)
Immunization - 781
Electronic File
E11-11424
Pertussis (Whooping Cough) Fact Sheet/Pertusis (La tos fernia) hoja de informes
Immunization - 781
Electronic File
E05-12869
Head Lice Fact Sheet #6: Head Lice Resources / Recursos sobre los piojos de la cabeza
School Health Program 685
Electronic File
E05-12868
Head Lice Fact Sheet #5: Myths, misconceptions, and truths about head lice treatments / Mitos, ideas
School Health Program 685
Electronic File
E05-12867
Head Lice Fact Sheet #4: How do I keep lice from coming back? / Como evito que vuelvan los piojos?
School Health Program 685
Electronic File
E05-12866
Head Lice Fact Sheet #3: What Should I do if I think my child has head lice? / Que debo hacer si
School Health Program 685
Electronic File
E05-12865
Head Lice Fact Sheet #2: How do I know if my child has head lice / Como se si mi hijo tiene piojos
School Health Program 685
Electronic File
E05-12864
Head Lice Fact Sheet #1: What are Lice? / Que son los Piojos?
School Health Program 685
Electronic File
E11-13208
Fact Sheet Varicella (Chickenpox) / Hoja informativa Varicela
Immunization - 293
Electronic File
E11-13223
Fact Sheet Tetanus (Lockjaw) / Hoja informativa Tetanos (Trismo)
Immunization - 293
Electronic File
E1-29
Everything you need to know about Head Lice / Todo lo que debe saber sobre los piojos
School Health Program 685
Electronic File
E59-11766
Information on Staphylococcal Infections for Day Care Facilities: for Parents
Infectious Disease - 400
Electronic File
11-11699P
Anyone Can Get Pertussis / A cualquiera le puede dar la tos ferina (Limit 50)
Immunization - 710
Posters
EC-9
Documenting History of Varicella (Chickenpox) Illness/Documentando la enfermedad de la varicela
Immunization - 781
Electronic File
11-11531P
Is it Just a Cough?/Es solamente una tos? (Pertussis Poster) (Limit 50)
Immunization - 710
Posters
9-202
Flu Fighters Activity Book / Luchadores contra la gripe librio de actividades
Warehouse
Coloring Books
E9-202
Flu Fighters Activity Book / Luchadores contra la gripe librio de actividades
Communications - 872
Electronic File
E59-11767
Information on Staphylococcal Infections School Athletic Depts: for Athlete
Infectious Disease - 400
Electronic File
E6-52
Prevent Dengue/Prevenga el dengue
Zoonosis - 376
Electronic File
Documenting History of Varicella-Chickenpox-Illness Form/Documentando la Enfermedad de la Varicela
Immunization - 710
Forms
C-9
Stock #4-25-lang Revised 10/25/2010
Page 169 of 221
Stock Number E11-13222
Title
Source (must print Contact List to have all necessary information)
Fact Sheet Rubella (German measles) / Hoja informativa Rubeola (Sarampion aleman)
Format
Immunization - 293
Electronic File
Community & Rural Health / Salud en la comunidad y Salud rural E56-13455
Office of Border Health Newsletter / Oficina de Salud Fronteriza Publicacion
Region 9/10 - Border Hlth - 880
Electronic Newsletter/Magazine
56-13455
Office of Border Health Newsletter / Oficina de Salud Fronteriza Publicacion
Region 9/10 - Border Hlth - 879
Newsletters
Concussion / Conmocion E6-80
Concussion Card/Child/Open Provider (yellow)/Las concusiones en los ninos
Epidemiology/Injury Surveillance - 351
Electronic File
E4-80
Concussion in Children: Signs and Symptoms of Brain Injury (Yellow)/Las concusiones en los ninos
EMS - 328
Electronic File
E4-81
Concussion: Signs and Symptoms of a Brain Injury Card (White) Adult version/Concusiones-signos y
EMS - 328
Electronic File
E6-81
Concussion Card/Adult/Open Provider/Concusiones-signos y sintomas de una lesion cerebral
Epidemiology/Injury Surveillance - 351
Electronic File
Consumer Health / Salud del consumidor ESP-000-4
Smart Shopping Saves Money Using Unit Price Labels/Al comprar inteligentemente usted ahorra dinero
Nutrition Services - 420
WIC Lesson/TrainingElectronic
E23-10446
Heimlich Maneuver Poster (Choking Poster)
Food Establishments - 713
Electronic File
E49-03199
Abusable Volatile Chemical Warning Poster
Abusive Volatile Chemicals Program - 192
Electronic File
ESP-000-16
You and Your Children Can Be Media Smart/Usted y sus hijos pueden estar conscientes de los efectos
Nutrition Services - 420
WIC Lesson/TrainingElectronic
49-03199
Abusable Volatile Chemical Warning Poster
Product Safety Div-Hazard Comm - 344
Posters
Dental Health / Salud dental EDH-000-05
Healthy Teeth, Part B / Dientes saludables, parte B
Nutrition Services - 639
WIC Lesson/TrainingElectronic
EDH-000-04
Healthy Teeth: A Guide for Parents of Preschoolers-Pt A/Dientes Saludables:Una guia para los padres
Nutrition Services - 639
WIC Lesson/TrainingElectronic
EF08-12878
Oral Health Questionnaire
Oral Health - 695
Electronic File
EDH-000-03
Take Time for Teeth / Tome tiempo para los dientes
Nutrition Services - 639
WIC Lesson/TrainingElectronic
EF08-12879
Dental Risk Assessment Questionnaire
Oral Health - 695
Electronic File
ESP-000-20
Weaning from the Bottle for Healthy Teeth and a Healthy Diet/Como quitarle el biberon al bebe para
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EEPSDT-26
Tips for Teens: Ways to Keep a Healthy Smile/Consejos para adolescentes: Como mantener una sonrisa
Oral Health - 597
Electronic File
EDH-000-06
Nothing But the Tooth / Ana y la Dentista
Nutrition Services - 639
WIC Lesson/TrainingElectronic
E8-17
Take Time for Teeth / Dedique tiempo a los dientes
Texas Health Steps - 24
Electronic File
EPB-000-04
Beautiful Teeth, Beautiful Smile / Dientes hermosas para una sonrisa hermosa
Nutrition Services - 420
WIC Lesson/TrainingElectronic
E08-12877
Your Child's Teeth are Important!
Oral Health - 597
Electronic File
EMN-000-12
Dental Health During Pregnancy / Salud dental durante el embarazo
Nutrition Services - 417
WIC Lesson/TrainingElectronic
Nutrition Services - 382
WIC Lesson/TrainingElectronic
Diabetes / Diabetes ENR-000-14
When Christina Got Smart-Preventing Diabetes and Heart Disease
Stock #4-25-lang Revised 10/25/2010
Page 170 of 221
Stock Number ENR-000-10
Title
Format
Source (must print Contact List to have all necessary information)
Diabetes Matters to Your Family/La diabetes es un tema importante para su familia
Nutrition Services - 382
WIC Lesson/TrainingElectronic
Disabilities & the Disabled / Discapacidades y Personas discapacitadas T-3
Children with Special Health Care Needs Application Book/Folleto de solicitud (Limit 25)
Warehouse
Forms
ET-3
Children with Special Health Care Needs Application Book/Folleto de solicitud
Children w/Special Health Care Needs - 692
Electronic File
13-183P
And Justice For All
Posters
Drugs / Drogas y farmacos E49-03199
Abusable Volatile Chemical Warning Poster
Abusive Volatile Chemicals Program - 192
Electronic File
49-03199
Abusable Volatile Chemical Warning Poster
Product Safety Div-Hazard Comm - 344
Posters
Ears & Hearing Disorders / Oidos y Trastornos de audicion EF05-12234
Hearing Checklist for Parents/Lista de comprobacion de audicion para los padres
PACT-Health Steps - 543
Electronic File
E1-86
My Ear Hurts-Ear Infections / Me duelen los oidas! Infeccion del Oido
PACT-Health Steps - 778
Electronic File
E1-186
Make Sure Your Baby Can Hear the Sounds of Texas/Asegurese de que su bebe pueda oir los sonidos de
Texas Health Steps - 24
Electronic File
E1-17
Helpful Hints for Healthy Hearing / Consejos Utiles para una Audicion Sana
Vision, Hearing and Spinal Screening - 372
Electronic File
Emergency Preparedness / Preparacion ante emergencias E4-2
Emergency & Disaster Planning / Planificacion de Emergencias y Desastres
Children w/Special Health Care Needs - 709
Electronic File
9-200
Emergency Document Bag / Bolsa de documentos de emergencia
Warehouse
Bag
Emergency Services / Servicios de emergencia E4-80
Concussion in Children: Signs and Symptoms of Brain Injury (Yellow)/Las concusiones en los ninos
EMS - 328
Electronic File
E4-81
Concussion: Signs and Symptoms of a Brain Injury Card (White) Adult version/Concusiones-signos y
EMS - 328
Electronic File
E6-81
Concussion Card/Adult/Open Provider/Concusiones-signos y sintomas de una lesion cerebral
Epidemiology/Injury Surveillance - 351
Electronic File
E6-80
Concussion Card/Child/Open Provider (yellow)/Las concusiones en los ninos
Epidemiology/Injury Surveillance - 351
Electronic File
Environmental Health / Salud ambiental F18-12025
Mold Remediation Company License Application
PSQA-Envir Hazards - 405
Forms
EF18-11676-BIL
Asbestos Application/Renewal Asbestos Inspector
Asbestos Program - 361
Electronic File
EF18-12025
Mold Remediation Company License Application
PSQA-Envir Hazards - 365
Electronic File
EF18-12023
Mold Assessment Consultant License Application
PSQA-Envir Hazards - 365
Electronic File
F18-12023
Mold Assessment Consultant License Application
PSQA-Envir Hazards - 405
Forms
EF18-12022
Mold Assessment Company License Application
PSQA-Envir Hazards - 365
Electronic File
EF18-12021
Mold Analysis Laboratory License Application
PSQA-Envir Hazards - 365
Electronic File
EF18-12020
Mold Training Course Approval Application
PSQA-Envir Hazards - 365
Electronic File
EF18-11681-BIL
Asbestos Application/Renewal Air Monitor Technician
Asbestos Program - 361
Electronic File
EF18-11680-BIL
Asbestos License Application/Renewal Project Manager
Asbestos Program - 361
Electronic File
EF18-12027
Mold Remediation Worker Registration Application
PSQA-Envir Hazards - 365
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 171 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF18-11677-BIL
Asbestos Application/Renewal Individual Asbestos Consultant
Asbestos Program - 361
Electronic File
EF18-12026
Mold Remediation Contractor License Application
PSQA-Envir Hazards - 365
Electronic File
EF18-11674-BIL
Asbestos License Application/Renewal Abatement Supervisor
Asbestos Program - 361
Electronic File
EF18-11673-BIL
Asbestos License Application/Renewal Asbestos Worker
Asbestos Program - 361
Electronic File
EF18-11671-BIL
Asbestos License Application/Renewal Operations & Maintenance Supervisor
Asbestos Program - 361
Electronic File
EF18-11669-BIL
Physician's Written Statement (Asbestos Program)
Asbestos Program - 361
Electronic File
EF18-11668-BIL
Asbestos Application Individual Duplicate
Asbestos Program - 361
Electronic File
EF18-11667-BIL
Asbestos Application Individual Name Change
Asbestos Program - 361
Electronic File
E49-03199
Abusable Volatile Chemical Warning Poster
Abusive Volatile Chemicals Program - 192
Electronic File
APB#1
Required Notice at all Asbestos Abatement Projects
PSQA-Envir Hazards - 162
Posters
49-03199
Abusable Volatile Chemical Warning Poster
Product Safety Div-Hazard Comm - 344
Posters
EF18-11679-BIL
Asbestos Application/Renewal Individual Management Planner
Asbestos Program - 361
Electronic File
F18-11680-BIL
Asbestos License Application/Renewal Project Manager
Asbestos - 148
Forms
F18-12059
Registration for State Mold Licensing Examination
Indoor Air Quality - 553
Forms
F18-12028
Mold Training Provider Accreditation Application
PSQA-Envir Hazards - 405
Forms
F18-12027
Mold Remediation Worker Registration Application
PSQA-Envir Hazards - 405
Forms
F18-12026
Mold Remediation Contractor License Application
PSQA-Envir Hazards - 405
Forms
F18-12024
Mold Assessment Technician License Application
PSQA-Envir Hazards - 405
Forms
F18-12022
Mold Assessment Company License Application
PSQA-Envir Hazards - 405
Forms
F18-12021
Mold Analysis Laboratory License Application
PSQA-Envir Hazards - 405
Forms
EF18-12024
Mold Assessment Technician License Application
PSQA-Envir Hazards - 365
Electronic File
F18-11681-BIL
Asbestos Application/Renewal Air Monitor Technician
Asbestos - 148
Forms
EF18-12028
Mold Training Provider Accreditation Application
PSQA-Envir Hazards - 365
Electronic File
F18-11679-BIL
Asbestos Application/Renewal Individual Management Planner
Asbestos - 148
Forms
F18-11667-BIL
Asbestos Application Individual Name Change
Asbestos - 148
Forms
F18-11676-BIL
Asbestos Application/Renewal Asbestos Inspector
Asbestos - 148
Forms
F18-11674-BIL
Asbestos License Application/Renewal Abatement Supervisor
Asbestos - 148
Forms
F18-11673-BIL
Asbestos License Application/Renewal Asbestos Worker
Asbestos - 148
Forms
F18-11671-BIL
Asbestos License Application/Renewal Operations & Maintenance Supervisor
Asbestos - 148
Forms
F18-11669-BIL
Physician's Written Statement (Asbestos Program)
Asbestos - 148
Forms
F18-11668-BIL
Asbestos Application Individual Duplicate
Asbestos - 148
Forms
F18-11677-BIL
Asbestos Application/Renewal Individual Asbestos Consultant
Asbestos - 148
Forms
F18-12020
Mold Training Course Approval Application
PSQA-Envir Hazards - 405
Forms
EF18-12059
Registration for State Mold Licensing Examination
PSQA-Envir Hazards - 365
Electronic File
Texas Health Steps - 24
Electronic File
Eyes & Vision Disorders / Ojos y Trastornos visuales EPSDT-24
Now I Can See the Sky! Vision Services
Family Planning / Planificacion familiar EF05-13227
DSHS Funding Source-Worksheet
Title V - 817
Electronic File
EF05-13226
Title X / XX Eligibility-Worksheet Instructions
Title V - 817
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 172 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF05-13225
Title X / XX Eligibility-Worksheet
Title V - 817
Electronic File
EF05-13228
DSHS Funding Source-Worksheet Instructions
Title V - 817
Electronic File
DSHS Funding Source-Screening and Eligibilty Form
Title V - 817
Electronic File
Food Establishments - 713
Electronic File
EF05-13229
First Aid / Primeros auxilios E23-10446
Heimlich Maneuver Poster (Choking Poster)
Food Safety & Hygiene / Seguridad alimenticia e Higiene EF23-13356
Cooling of Cooked Potentially Hazardous Foods / Enfriamiento de alimentos cocidos con el riesgo de
Food Establishment - 748
Electronic File
E23-10446
Heimlich Maneuver Poster (Choking Poster)
Food Establishments - 713
Electronic File
E23-12784
Food Temperatures/Temperaturas
Food Establishments - 713
Electronic File
F23-13363
Time as a Public Health Control / Tiempo como control de salud publico
Food Establishments - 810
Forms
ESP-000-1
Storing Leftovers Safely / Guarde las sobras para que no se echen a perder
Nutrition Services - 420
WIC Lesson/TrainingElectronic
E1-308
Lead in Your Food and Remedies / Plomo en su comida y en remedies caseros
Childhood Lead Poisoning - 386
Electronic File
EF23-13363
Time as a Public Health Control / Tiempo como control de salud publico
Food Establishments - 713
Electronic File
EFS-000-02
Kitchen Food Safety-Fighting Bacteria/Seguridad en la cocina con los alimentos:combate la bacteria
Nutrition Services - 413
WIC Lesson/TrainingElectronic
Forms / Formularios F07-12808
Glenda Dawson Donate Life-Texas Registry Registration Form / Formulario de inscripcion en el registr
Donate Life Texas Registry - 718
Forms
F07-13429
Client Drug Co-Pay Reimbursement Request Form/Solicitud del cliente para el reembolso del copago
Children w/Special Health Care Needs - 681
Forms
EPB-100
Lead Assessment Interview Tool (Childhood Lead Poisoning Prevention Prog)
Childhood Lead Poisoning - 385
Electronic File
F07-12840
School Attendance Verification / Verificacion de asistencia a la escuela
Children w/Special Health Care Needs - 681
Forms
EM-70
Application for Hearing Service / Aplicacion de Programa de Amplificacion para los Ninos de Texas
Audiology - 440
Electronic File
F07-12827
FSS Provider Application
Children w/Special Health Care Needs - 681
Forms
EPB-110
Abbreviated Parent Questionnaire/Guidelines (lead poisoning)/Cuestionario abreviado para los padres
Childhood Lead Poisoning - 385
Electronic File
F07-12780
Medication Form (CSHCN)/ Control de medicamentos
Children w/Special Health Care Needs - 681
Forms
EL-36
General Consent and Disclosure / Informacion y consentimiento
Public Health Nursing - 263 Electronic File
F07-12606
Photo Release Form/Declaracion de consentimiento y liberacion de responsabilidad para fotos
Children w/Special Health Care Needs - 681
Forms
F07-12595
CSHCN Address Change Form/Formulario para cambio de direccion
Children w/Special Health Care Needs - 681
Forms
F07-12585
Application for Insurance Premium Payment Assistance/Solicitud para asistencia con pagos de prima
Children w/Special Health Care Needs - 681
Forms
F07-12540
Emergency Information Form / Formulario de Informacion para Emergencias
Children w/Special Health Care Needs - 681
Forms
EL-30
Author to Release Confidential Info/Release of Medical Info (no print copy available)
Public Health Nursing - 263 Electronic File
ET-3
Children with Special Health Care Needs Application Book/Folleto de solicitud
Children w/Special Health Care Needs - 692
Electronic File
ET-3-4
CSHCN Physician/Dentist Assessment Form / Formulario de Evaluacion del Medico/Dentista
Children w/Special Health Care Needs - 697
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 173 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EWICR14
What to Bring to Your WIC Appointment / Lo que debe traer a su cita de WIC
Nutrition Services - 401
Electronic File
F07-13148
Form to Release CSHCN Services Program Claims History / Formulario para divulgar el historial de
Children w/Special Health Care Needs - 681
Forms
EVS-2271
Texas Voluntary Adoption Registry Registration Application (Central Adoption Registry Application)
Vital Statistics - 346
Electronic File
ET-3-1
CSHCN Services Program Basic Application Form/Solicitud basica para el Programa de Servicios CSHCN
Children w/Special Health Care Needs - 692
Electronic File
G-THSTEPS
THSteps Specimen Submission Form
Labs - 818
Forms
T-3-1
CSHCN Services Program Basic Application Form/Solicitud basica para el Programa de Servicios CSHCN
Children w/Special Health Care Needs - 681
Forms
T-3
Children with Special Health Care Needs Application Book/Folleto de solicitud (Limit 25)
Warehouse
Forms
F13-06-12042
EBT Participant Transfer Form (Restricted to WIC Local Agencies)
WICR14
What to Bring to Your WIC Appointment / Lo que debe traer a su cita de WIC
Nutrition Services - 885
Forms
F11-13366
ImmTrac Adult Consent Form / ImmTrac formulario de consentimiento para adultos
Immunization - 293
Forms
F11-12956
Immunization Registry (ImmTrac) Disaster Information Retention Consent Form
Immunization - 293
Forms
WIC-42
Diet Health History for Infants/Historia de salud alimentaria para bebes (restrict to Texas WIC)
Nutrition Services - 885
Forms
T-3-3
Rights and Responsibilities Form (CSHCN) / Formulario de derechos y responsabilidades
Children w/Special Health Care Needs - 681
Forms
T-3-2
Health Insurance Data Form (CSHCN) / Formulario de datos del seguro medico
Children w/Special Health Care Needs - 681
Forms
F18-12059
Registration for State Mold Licensing Examination
Indoor Air Quality - 553
Forms
WICR02
Verification of Residency
Nutrition Services - 885
Forms
F07-12828
FSS Provider Short-term Application
Children w/Special Health Care Needs - 681
Forms
F11-11936
ImmTrac Newborn Consent Form
Immunization - 293
Forms
WIC-5
Notice of Participant Ineligibility
Nutrition Services - 885
Forms
WIC-45
Diet History for Pregnant/Breastfeeding/Postpartum Women/Historia medica para(restrict to Texas WIC)
Nutrition Services - 885
Forms
WIC-19A
Formulario para documentacion de ayuda de sustento / WIC Assistance Documentation Form
Nutrition Services - 885
Forms
WIC-26
Growing Healthy Families
Nutrition Services - 885
Forms
WIC-35-1A
Supplemental Information Form / Forma de informacion adicional
Nutrition Services - 885
Forms
WIC-44
Health History for Children/Historia medica para ninos (restrict to Texas WIC)
Nutrition Services - 885
Forms
T-3-4
CSHCN Physician/Dentist Assessment Form / Formulario de Evaluacion del Medico/Dentista
Children w/Special Health Care Needs - 681
Forms
F11-12955
Immunization Registry (ImmTrac) First Responder/Family Member Request Form
Immunization - 293
Forms
WIC-35-3
WIC Income Questionnaire / Cuestionario del programa WIC sobre los ingresos
Nutrition Services - 885
Forms
F23-13363
Time as a Public Health Control / Tiempo como control de salud publico
Food Establishments - 810
Forms
EF23-13363
Time as a Public Health Control / Tiempo como control de salud publico
Food Establishments - 713
Electronic File
C-62
Adolescent Vaccination Reminder Card / Tarjeta de Recordatorio de Vacunacion de Adolescente
Immunization - 710
Forms
Stock #4-25-lang Revised 10/25/2010
Forms
Page 174 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF21-11810
Statement of Applicants Rights and Responsibilities / Declaracion de los derechos (Title V)
Title V - 461
Electronic File
C-61
Adult Vaccination Reminder Card / Tarjeta de Recordatorio de Vacunacion de Adulto
Immunization - 710
Forms
C-104
Adult Immunization Record Card/Registro de vacunacion para adultos
Immunization - 710
Forms
C-63
Clinic Delinquent Reminder Card/Tarjeta recordatorio de la clinica sobre vacunas (Limit 500)
Immunization - 710
Forms
C-102
Personal Immunization Record/Registro de Inmunizaciones
Immunization - 710
Forms
C-100
Vaccine Information Documentation Form/Forma de documentacion de vacuna
Immunization - 710
Forms
EF23-13356
Cooling of Cooked Potentially Hazardous Foods / Enfriamiento de alimentos cocidos con el riesgo de
Food Establishment - 748
Electronic File
EF18-12059
Registration for State Mold Licensing Examination
PSQA-Envir Hazards - 365
Electronic File
EF05-13229
DSHS Funding Source-Screening and Eligibilty Form
Title V - 817
Electronic File
C-10
Texas VFC-Patient Eligibility Screening Form/Archivo que determina la elegibilidad del paciente
Immunization - 710
Forms
C-9
Documenting History of Varicella-Chickenpox-Illness Form/Documentando la Enfermedad de la Varicela
Immunization - 710
Forms
EF11-12956-P
Immunization Registry (ImmTrac) Disaster Information Retention Consent Form
Immunization - 887
Electronic File
EF11-11936
ImmTrac Newborn Consent Form
Immunization - 887
Electronic File
EF07-12827
FSS Provider Application
Children w/Special Health Care Needs - 697
Electronic File
EF07-12540
Emergency Information Form / Formulario de Informacion para Emergencias
Children w/Special Health Care Needs - 709
Electronic File
EF07-12585
Application for Insurance Premium Payment Assistance/Solicitud para asistencia con pagos de prima
Children w/Special Health Care Needs - 709
Electronic File
EF07-12808
Glenda Dawson Donate Life-Texas Registry Registration Form / Formulario de inscripcion en el registr
Donate Life Texas Registry - 719
Electronic File
EF07-12595
CSHCN Address Change Form/Formulario para cambio de direccion
Children w/Special Health Care Needs - 692
Electronic File
EF11-13366
ImmTrac Adult Consent Form / ImmTrac formulario de consentimiento para adultos
Immunization - 779
Electronic File
EC-10
Texas VFC-Patient Eligibility Screening Form/Archivo que determina la elegibilidad del paciente
Immunization - 781
Electronic File
EC-9
Documenting History of Varicella (Chickenpox) Illness/Documentando la enfermedad de la varicela
Immunization - 781
Electronic File
EC-63
Clinic Delinquent Reminder Card/Tarjeta recordatorio de la clinica sobre vacunas (non-postage)
Immunization - 781
Electronic File
EC-62
Adolescent Vaccination Reminder Card / Tarjeta de Recordatorio de Vacunacion de Adolescente
Immunization - 781
Electronic File
EC-61
Adult Vaccination Reminder Card / Tarjeta de Recordatorio de Vacunacion de Adulto
Immunization - 781
Electronic File
EC-104
Adult Immunization Record Card/Registro de vacunacion para adultos
Immunization - 781
Electronic File
EF05-13228
DSHS Funding Source-Worksheet Instructions
Title V - 817
Electronic File
EC-100
Vaccine Information Documentation Form/Forma de documentacion de vacuna
Immunization - 781
Electronic File
EF07-12780
Medication Form (CSHCN)/ Control de medicamentos
Children w/Special Health Care Needs - 709
Electronic File
CPW-13E-S
Case Management Client Satisfaction Survey / Encuesta de Opinion del Cliente
Case Management - 309
Electronic File
CPW-09E-S
Case Management Case Transfer / Documento para transferir los casos
Case Management - 309
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 175 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
CPW-08E-S
Case Management Case Closure Form / Documento para cerrar los casos
Case Management - 309
Electronic File
CPW-07E-S
Case Management Referral Form / Formulario de recomendacion del caso
Case Management - 309
Electronic File
EF05-13225
Title X / XX Eligibility-Worksheet
Title V - 817
Electronic File
CPW-03Signature
Case Management Service Plan Signature Page/Plan de Servicios
Case Management - 309
Electronic File
EF05-13226
Title X / XX Eligibility-Worksheet Instructions
Title V - 817
Electronic File
CPW-03E-S
Case Management Service Plan/Plan de Servicios
Case Management - 309
Electronic File
CIHCP Form 100
CIHCP Application for Assistance (County Indigent)/Solicitud de Asistencia De Atencion Medica
Indigent Health Program 421
Electronic File
EF05-13227
DSHS Funding Source-Worksheet
Title V - 817
Electronic File
EC-102
Personal Immunization Record/Registro de Inmunizaciones
Immunization - 781
Electronic File
DSHS Funding Source-Screening and Eligibilty Form
Title V - 817
Electronic File
EF05-13227
DSHS Funding Source-Worksheet
Title V - 817
Electronic File
EF05-13226
Title X / XX Eligibility-Worksheet Instructions
Title V - 817
Electronic File
EF05-13225
Title X / XX Eligibility-Worksheet
Title V - 817
Electronic File
EC-10
Texas VFC-Patient Eligibility Screening Form/Archivo que determina la elegibilidad del paciente
Immunization - 781
Electronic File
C-10
Texas VFC-Patient Eligibility Screening Form/Archivo que determina la elegibilidad del paciente
Immunization - 710
Forms
CIHCP Form 100
CIHCP Application for Assistance (County Indigent)/Solicitud de Asistencia De Atencion Medica
Indigent Health Program 421
Electronic File
ET-3-1
CSHCN Services Program Basic Application Form/Solicitud basica para el Programa de Servicios CSHCN
Children w/Special Health Care Needs - 692
Electronic File
EF05-13228
DSHS Funding Source-Worksheet Instructions
Title V - 817
Electronic File
WIC-35-3
WIC Income Questionnaire / Cuestionario del programa WIC sobre los ingresos
Nutrition Services - 885
Forms
EF21-11810
Statement of Applicants Rights and Responsibilities / Declaracion de los derechos (Title V)
Title V - 461
Electronic File
T-3
Children with Special Health Care Needs Application Book/Folleto de solicitud (Limit 25)
Warehouse
Forms
WICR14
What to Bring to Your WIC Appointment / Lo que debe traer a su cita de WIC
Nutrition Services - 885
Forms
EWICR14
What to Bring to Your WIC Appointment / Lo que debe traer a su cita de WIC
Nutrition Services - 401
Electronic File
T-3-1
CSHCN Services Program Basic Application Form/Solicitud basica para el Programa de Servicios CSHCN
Children w/Special Health Care Needs - 681
Forms
T-3-3
Rights and Responsibilities Form (CSHCN) / Formulario de derechos y responsabilidades
Children w/Special Health Care Needs - 681
Forms
ET-3
Children with Special Health Care Needs Application Book/Folleto de solicitud
Children w/Special Health Care Needs - 692
Electronic File
EM-70
Application for Hearing Service / Aplicacion de Programa de Amplificacion para los Ninos de Texas
Audiology - 440
Electronic File
T-3-2
Health Insurance Data Form (CSHCN) / Formulario de datos del seguro medico
Children w/Special Health Care Needs - 681
Forms
PSQA-Envir Hazards - 405
Forms
Forms-Eligibility / Formularios--elegibilidad EF05-13229
Forms-Licensing / Formularios--autorizacion F18-12024
Mold Assessment Technician License Application
F18-11681-BIL
Asbestos Application/Renewal Air Monitor Technician
Asbestos - 148
Forms
EF18-11677-BIL
Asbestos Application/Renewal Individual Asbestos Consultant
Asbestos Program - 361
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 176 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F18-11680-BIL
Asbestos License Application/Renewal Project Manager
Asbestos - 148
Forms
F18-12026
Mold Remediation Contractor License Application
PSQA-Envir Hazards - 405
Forms
F18-12025
Mold Remediation Company License Application
PSQA-Envir Hazards - 405
Forms
EF18-11679-BIL
Asbestos Application/Renewal Individual Management Planner
Asbestos Program - 361
Electronic File
F18-12023
Mold Assessment Consultant License Application
PSQA-Envir Hazards - 405
Forms
EF18-11680-BIL
Asbestos License Application/Renewal Project Manager
Asbestos Program - 361
Electronic File
EF18-11676-BIL
Asbestos Application/Renewal Asbestos Inspector
Asbestos Program - 361
Electronic File
F18-12021
Mold Analysis Laboratory License Application
PSQA-Envir Hazards - 405
Forms
EF18-11674-BIL
Asbestos License Application/Renewal Abatement Supervisor
Asbestos Program - 361
Electronic File
EF18-11673-BIL
Asbestos License Application/Renewal Asbestos Worker
Asbestos Program - 361
Electronic File
EF18-11671-BIL
Asbestos License Application/Renewal Operations & Maintenance Supervisor
Asbestos Program - 361
Electronic File
EF18-11669-BIL
Physician's Written Statement (Asbestos Program)
Asbestos Program - 361
Electronic File
EF18-11668-BIL
Asbestos Application Individual Duplicate
Asbestos Program - 361
Electronic File
EF18-11667-BIL
Asbestos Application Individual Name Change
Asbestos Program - 361
Electronic File
F18-11679-BIL
Asbestos Application/Renewal Individual Management Planner
Asbestos - 148
Forms
F18-12022
Mold Assessment Company License Application
PSQA-Envir Hazards - 405
Forms
EF18-11681-BIL
Asbestos Application/Renewal Air Monitor Technician
Asbestos Program - 361
Electronic File
EF18-12023
Mold Assessment Consultant License Application
PSQA-Envir Hazards - 365
Electronic File
F18-11667-BIL
Asbestos Application Individual Name Change
Asbestos - 148
Forms
F18-11668-BIL
Asbestos Application Individual Duplicate
Asbestos - 148
Forms
F18-11669-BIL
Physician's Written Statement (Asbestos Program)
Asbestos - 148
Forms
F18-12059
Registration for State Mold Licensing Examination
Indoor Air Quality - 553
Forms
EF18-12025
Mold Remediation Company License Application
PSQA-Envir Hazards - 365
Electronic File
EF18-12021
Mold Analysis Laboratory License Application
PSQA-Envir Hazards - 365
Electronic File
F18-11671-BIL
Asbestos License Application/Renewal Operations & Maintenance Supervisor
Asbestos - 148
Forms
EF18-12020
Mold Training Course Approval Application
PSQA-Envir Hazards - 365
Electronic File
F23-13363
Time as a Public Health Control / Tiempo como control de salud publico
Food Establishments - 810
Forms
EF18-12024
Mold Assessment Technician License Application
PSQA-Envir Hazards - 365
Electronic File
EF18-12026
Mold Remediation Contractor License Application
PSQA-Envir Hazards - 365
Electronic File
EF18-12022
Mold Assessment Company License Application
PSQA-Envir Hazards - 365
Electronic File
EF23-13363
Time as a Public Health Control / Tiempo como control de salud publico
Food Establishments - 713
Electronic File
EF18-12028
Mold Training Provider Accreditation Application
PSQA-Envir Hazards - 365
Electronic File
EF18-12027
Mold Remediation Worker Registration Application
PSQA-Envir Hazards - 365
Electronic File
F18-12027
Mold Remediation Worker Registration Application
PSQA-Envir Hazards - 405
Forms
F18-11674-BIL
Asbestos License Application/Renewal Abatement Supervisor
Asbestos - 148
Forms
EF18-12059
Registration for State Mold Licensing Examination
PSQA-Envir Hazards - 365
Electronic File
F18-12028
Mold Training Provider Accreditation Application
PSQA-Envir Hazards - 405
Forms
F18-11673-BIL
Asbestos License Application/Renewal Asbestos Worker
Asbestos - 148
Forms
Asbestos Application/Renewal Asbestos Inspector
Asbestos - 148
Forms
F18-11676-BIL
Stock #4-25-lang Revised 10/25/2010
Page 177 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF23-13356
Cooling of Cooked Potentially Hazardous Foods / Enfriamiento de alimentos cocidos con el riesgo de
Food Establishment - 748
Electronic File
F18-12020
Mold Training Course Approval Application
PSQA-Envir Hazards - 405
Forms
F18-11677-BIL
Asbestos Application/Renewal Individual Asbestos Consultant
Asbestos - 148
Forms
Forms-Reporting / Formularios--reportajes EF18-11669-BIL
Physician's Written Statement (Asbestos Program)
Asbestos Program - 361
Electronic File
F18-11669-BIL
Physician's Written Statement (Asbestos Program)
Asbestos - 148
Forms
Vital Statistics - 346
Electronic File
Forms-Vital Statistics / Formularios de Estadisticas Vital EVS-2271
Texas Voluntary Adoption Registry Registration Application (Central Adoption Registry Application)
Genetics / Genetica E05-10513
What is Galactosemia? / Que es la Galactosemia?
Newborn Screening - 318
Electronic File
E1-195A
Primary Hypothyroidism / Hipotiroidismo Primario Guia de Diagnostico y Tratamiento
Newborn Screening - 317
Electronic File
E1-321
10 Things Parents Want to Know about NBS/10 Cosas que los padres desean saber sobre el examen
Newborn Screening - 68
Electronic File
E1-65
What is Phenylketonuria? / Que es la fenilcetonuria?
Newborn Screening - 281
Electronic File
1-158
Newborn Screening Poster
Warehouse
Posters
Nutrition Services - 382
WIC Lesson/TrainingElectronic
Heart Disease & Hypertension / Enfermedad cardiaca e Hipertension ENR-000-14
When Christina Got Smart-Preventing Diabetes and Heart Disease
Hepatitis / Hepatitis E11-13211
Fact Sheet Hepatitis A (Hep A) / Hoja informativa Hepatitis A (Hep A)
Immunization - 293
Electronic File
E11-13212
Fact Sheet Hepatitis B (Hep B) / Hoja informativa Hepatitis B (Hep B)
Immunization - 293
Electronic File
E6-12C
Hepatitis C Can Be Prevented! / La Hepatitis C puede ser prevenida! Hepatitis C Pamphlet)
Infectious Disease - 533
Electronic File
E6-12A
Hepatitis A Can Be Prevented! / La Hepatitis A puede ser prevenda! (Hepatitis A Pamphlet)
Infectious Disease - 600
Electronic File
E6-12B
Hepatitis B Can Be Prevented! / La Hepatitis B puede ser prevenida! (Hepatitis B Pamphlet)
Infectious Disease - 601
Electronic File
Is it Just a Cough?/Es solamente una tos? (Pertussis Poster)
Immunization - 781
Electronic File
E11-13209
Fact Sheet Diphtheria / Hoja informativa Difteria
Immunization - 293
Electronic File
E11-13208
Fact Sheet Varicella (Chickenpox) / Hoja informativa Varicela
Immunization - 293
Electronic File
E11-12953
Instructions - Exemption from Immunization for Reasons of Conscience Form / Instrucciones-Execion de
Immunization - 780
Electronic File
E11-12816P
Comfort Measures (8-1/2" X 11"poster) / Metados para confortar
Immunization - 781
Electronic File
E11-12816
Comfort Measures / Metados para confortar
Immunization - 781
Electronic File
E11-12812
Influenza (Flu) Fact Sheet for Child-Care Settings / Influenza (La gripe): hoja de informes para gua
Immunization - 781
Electronic File
E11-11424
Pertussis (Whooping Cough) Fact Sheet/Pertusis (La tos fernia) hoja de informes
Immunization - 781
Electronic File
EF11-12956-P
Immunization Registry (ImmTrac) Disaster Information Retention Consent Form
Immunization - 887
Electronic File
E11-11166
Your Child May be Eligible for Free Vaccine/Es posible que su nino cubra los requisitos (poster)
Immunization - 781
Electronic File
Immunization / Inmunizacion E11-11531P
Stock #4-25-lang Revised 10/25/2010
Page 178 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
C-63
Clinic Delinquent Reminder Card/Tarjeta recordatorio de la clinica sobre vacunas (Limit 500)
Immunization - 710
Forms
E11-11117
I'm Invincible - Vaccines Provide Protection When Your Baby Needs It Most/Vacunas dan proteccion
Immunization - 781
Electronic File
EF11-13140
Sample Request for Exemption from Immunizations for Reasons of Conscience
Immunization - 780
Electronic File
E11-11699P
Anyone Can Get Pertussis / A cualquiera le puede dar la tos ferina
Immunization - 781
Electronic File
E11-13217
Fact Sheet Mumps / Hoja informativa Paperas
Immunization - 293
Electronic File
E6-14
Minimum State Vaccine Requirements for Texas School Entrance/Attendance/Requisitos estatales minimos
Immunization - 781
Electronic File
E11-13223
Fact Sheet Tetanus (Lockjaw) / Hoja informativa Tetanos (Trismo)
Immunization - 293
Electronic File
E11-13222
Fact Sheet Rubella (German measles) / Hoja informativa Rubeola (Sarampion aleman)
Immunization - 293
Electronic File
E11-13221
Fact Sheet Rotavirus / Hoja informativa Rotavirus
Immunization - 293
Electronic File
E11-13220
Fact Sheet Poliomelitis (Polio) / Hoja informativa Poliomieliis (Polio)
Immunization - 293
Electronic File
E11-13215
Fact Sheet Measles / Hoja informativa Sarampion
Immunization - 293
Electronic File
E11-13218
Fact Sheet Pertussis (Whooping Cough) / Hoja informativa Pertusis (Tos Ferina)
Immunization - 293
Electronic File
E11-13211
Fact Sheet Hepatitis A (Hep A) / Hoja informativa Hepatitis A (Hep A)
Immunization - 293
Electronic File
6-27P
How to Administer Injections Poster/Sitios anatomicos de vacunacion - 13" x 27" (Limit 50)
Immunization - 710
Posters
E11-13216
Fact Sheet Meningococcal Disease / Hoja informativa Enfermedad meningococica
Immunization - 293
Electronic File
C-62
Adolescent Vaccination Reminder Card / Tarjeta de Recordatorio de Vacunacion de Adolescente
Immunization - 710
Forms
E11-13214
Fact Sheet Human Papillomavirus (HPV) / Hoja informativa Virus de papiloma humano (HPV)
Immunization - 293
Electronic File
E11-13213
Fact Sheet Herpes Zoster (Shingles) / Hoja informativa Herpes zoster (Culebrilla)
Immunization - 293
Electronic File
E11-13212
Fact Sheet Hepatitis B (Hep B) / Hoja informativa Hepatitis B (Hep B)
Immunization - 293
Electronic File
E11-13219
Fact Sheet Pneumococcal Disease / Hoja informativa Enfermedad neumococica
Immunization - 293
Electronic File
EC-104
Adult Immunization Record Card/Registro de vacunacion para adultos
Immunization - 781
Electronic File
EC-63
Clinic Delinquent Reminder Card/Tarjeta recordatorio de la clinica sobre vacunas (non-postage)
Immunization - 781
Electronic File
EC-62
Adolescent Vaccination Reminder Card / Tarjeta de Recordatorio de Vacunacion de Adolescente
Immunization - 781
Electronic File
EC-61
Adult Vaccination Reminder Card / Tarjeta de Recordatorio de Vacunacion de Adulto
Immunization - 781
Electronic File
11-12797
Protect Your Entire Family Against Pertussis / Proteja a toda su familia contra la tos ferina-Poster
Immunization - 293
Posters
11-11965P
Play it Safe. Vaccinate. Poster
Immunization - 293
Posters
11-11699P
Anyone Can Get Pertussis / A cualquiera le puede dar la tos ferina (Limit 50)
Immunization - 710
Posters
11-11531P
Is it Just a Cough?/Es solamente una tos? (Pertussis Poster) (Limit 50)
Immunization - 710
Posters
6-306
Every Dose Counts-4th DTaP / Cada Vacuna Cuenta 4ta DTaP Poster (18" x 25")
Immunization - 710
Posters
EF11-11936
ImmTrac Newborn Consent Form
Immunization - 887
Electronic File
ImmTrac Adult Consent Form / ImmTrac formulario de consentimiento para adultos
Immunization - 293
Forms
F11-13366
Stock #4-25-lang Revised 10/25/2010
Page 179 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EC-102
Personal Immunization Record/Registro de Inmunizaciones
Immunization - 781
Electronic File
EC-100
Vaccine Information Documentation Form/Forma de documentacion de vacuna
Immunization - 781
Electronic File
EC-10
Texas VFC-Patient Eligibility Screening Form/Archivo que determina la elegibilidad del paciente
Immunization - 781
Electronic File
E6-27P
How to Administer Injections Poster/Sitios anatomicos de vacunacion (Poster 13" x 27")
Immunization - 781
Electronic File
E6-202P
Love Them and Protect Them/Amelos. Protejalos (ImmTrac Poster) (8-1/2" x 11")
Immunization - 781
Electronic File
E6-202
Love Them and Protect Them/Amelos. Protejalos (ImmTrac Brochure)
Immunization - 781
Electronic File
E6-15
Minimum State Vaccine Requirements for Texas Child-Care Facilities/Requisitos estatales minimos
Immunization - 781
Electronic File
F11-12955
Immunization Registry (ImmTrac) First Responder/Family Member Request Form
Immunization - 293
Forms
11-12855P
Remember the 4th DTaP / Recuerda la 4a DTaP (poster)
Immunization - 293
Posters
C-102
Personal Immunization Record/Registro de Inmunizaciones
Immunization - 710
Forms
C-100
Vaccine Information Documentation Form/Forma de documentacion de vacuna
Immunization - 710
Forms
C-10
Texas VFC-Patient Eligibility Screening Form/Archivo que determina la elegibilidad del paciente
Immunization - 710
Forms
C-61
Adult Vaccination Reminder Card / Tarjeta de Recordatorio de Vacunacion de Adulto
Immunization - 710
Forms
6-305
Every Dose Counts-4th DTaP / Cada Vacuna Cuenta 4ta DTaP Poster (18" x 24")
Immunization - 710
Posters
11-11166
Your Child May be Eligible for Free Vaccine/Es posible que su nino cubra los requisitos (Limit 50)
Immunization - 710
Posters
6-202P
Love Them and Protect Them/Amelos. Protejalos 11" x 25" (ImmTrac Poster)
Immunization - 710
Posters
11-12816P
Comfort Measures (19" x 25" poster) / Metados para confortar
Immunization - 710
Posters
11-13132
Good Health Can Last a Lifetime / La salud buena purede durar una vida (bookmark)
Immunization - 293
Bookmarks
11-12844P
Good Health Can Last a Lifetime / Buena salud puede durar una vida (11 x 17 vertical-poster-Teens)
Immunization - 293
Posters
11-12854P
Vaccinate for Life / Vacuna Para La Vida (17" x 24" Adult Immunization Poster)
Immunization - 293
Posters
11-12853P
Vaccinate for Life / Vacuna Para La Vida (11" x 17" Adult Immunization Poster)
Immunization - 293
Posters
11-12848P
Good Health Can Last a Lifetime / Buena salud puede durar una vida (17x24-vertical-poster-Teens)
Immunization - 293
Posters
EF11-13366
ImmTrac Adult Consent Form / ImmTrac formulario de consentimiento para adultos
Immunization - 779
Electronic File
F11-11936
ImmTrac Newborn Consent Form
Immunization - 293
Forms
11-12845P
Good Health Can Last a Lifetime / Buena salud puede durar una vida (11 x 17 horiz-poster-Teens)
Immunization - 293
Posters
F11-12956
Immunization Registry (ImmTrac) Disaster Information Retention Consent Form
Immunization - 293
Forms
C-104
Adult Immunization Record Card/Registro de vacunacion para adultos
Immunization - 710
Forms
11-13175M
Baby Immunization Schedule Photo Frame Magnet/Bebe Calendario de vacunacion-iman marco para foto
Immunization - 293
Magnets
F11-13140
Sample Request for Exemption from Immunizations for Reasons of Conscience
Immunization - 293
Forms
Stock #4-25-lang Revised 10/25/2010
Page 180 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Infants - Care & Hygiene / Bebes--su cuidado e higiene ESP-000-15
Your Baby's Beautiful Teeth/Los hermosos dientes de su bebe
Nutrition Services - 420
WIC Lesson/TrainingElectronic
E1-321
10 Things Parents Want to Know about NBS/10 Cosas que los padres desean saber sobre el examen
Newborn Screening - 68
Electronic File
ESP-000-20
Weaning from the Bottle for Healthy Teeth and a Healthy Diet/Como quitarle el biberon al bebe para
Nutrition Services - 420
WIC Lesson/TrainingElectronic
E1-320
Things to Know about Cystic Fibrosis/Lo que debe saber sobre la fibrosis cistica
Newborn Screening - 68
Electronic File
E1-452
Safe Sleep for Babies / Ponga a los bebes a dormir sin peligro
Title V-Family Hlth - 765
Electronic File
EMN-000-09
New Baby Care: Keeping Your Baby Healthy and Happy / Cuidado del nuevo bebe: Manteniendo a su bebe
Nutrition Services - 417
WIC Lesson/TrainingElectronic
E1-186
Make Sure Your Baby Can Hear the Sounds of Texas/Asegurese de que su bebe pueda oir los sonidos de
Texas Health Steps - 24
Electronic File
1-158
Newborn Screening Poster
Warehouse
Posters
Infants - Nutrition / Bebes--su nutricion E13-16
Mother's Milk: Baby's First Immunization / La leche materna: La primer vacuna para su bebe
Nutrition Services - 570
Electronic File
ESP-000-18
Growing up from a Baby to a Toddler/El desarrollo de bebe a nino pequeno
Nutrition Services - 420
WIC Lesson/TrainingElectronic
13-16
Mother's Milk: Baby's First Immunization / La leche materna: La primer vacuna para su bebe
EIF-000-20
Fit Families: Baby Talk About Food/Familias en forma: Hablamos de la comida para babes
Nutrition Services - 416
WIC Lesson/TrainingElectronic
ESP-000-20
Weaning from the Bottle for Healthy Teeth and a Healthy Diet/Como quitarle el biberon al bebe para
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EIF-000-18
Watch Me Grow / Mira como crezco
Nutrition Services - 416
WIC Lesson/TrainingElectronic
EIF-000-17
Starting Solid Foods / Como empezar a dar alimentos solidos
Nutrition Services - 416
WIC Lesson/TrainingElectronic
EIF-000-16
Baby's First Spoonful: Tips for Starting Solids/El primer bocado de bebe: Consejos para introducir
Nutrition Services - 416
WIC Lesson/TrainingElectronic
EIF-000-15
Feeding Your Infant 8-12 Months / Alimentando a su bebe a los 8-12 meses
Nutrition Services - 416
WIC Lesson/TrainingElectronic
EIF-000-14
Weaning from the Bottle / Dejando de tomar el biberon
Nutrition Services - 416
WIC Lesson/TrainingElectronic
EIF-000-13
Formula Preparation / La preparacionde formula para bebes
Nutrition Services - 416
WIC Lesson/TrainingElectronic
EIF-000-10
Look Who's Eating / Miren quien esta comiendo
Nutrition Services - 416
WIC Lesson/TrainingElectronic
ERB-000-14
Feed Your Child's Future / Alimente el futuro de su nino
Nutrition Services - 419
WIC Lesson/TrainingElectronic
Posters
Kidney Health / Salud del rinon EKHC-1105-C
Important Information about Medicare Rx and Your KHC Benefits
Kidney Health Care - 777
Electronic File
E41-12574
Filing Deadlines and Benefit Limits for Medicare Part D/ Fechas limites para reclamaciones y limites
Kidney Health Care - 688
Electronic File
E41-12580
Guide to Your KHC Drug Benefits / Guia a sus beneficios de KHC para medicamentos
Kidney Health Care - 688
Electronic File
Laboratories & Laboratory Safety / Laboratorios y Seguridad de laboratorios G-THSTEPS
THSteps Specimen Submission Form
Stock #4-25-lang Revised 10/25/2010
Labs - 818
Forms
Page 181 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Lead Poisoning / Intoxicacion por plomo E1-307
Lead Around the Home / Plomo alrededor de la casa
Childhood Lead Poisoning - 386
Electronic File
EPB-110
Abbreviated Parent Questionnaire/Guidelines (lead poisoning)/Cuestionario abreviado para los padres
Childhood Lead Poisoning - 385
Electronic File
E1-311
How Lead Affects Your Child / Como dana el plomo a mi nino
Childhood Lead Poisoning - 386
Electronic File
E1-310
My Child has a High Lead Level / Mi nino tiene un alto nivel de plomo
Childhood Lead Poisoning - 386
Electronic File
E09-13409
How to Protect Your Family from Lead Exposure / Como proteger a su familia del plomo
Blood Lead Epi - 863
Electronic File
E1-308
Lead in Your Food and Remedies / Plomo en su comida y en remedies caseros
Childhood Lead Poisoning - 386
Electronic File
EPB-100
Lead Assessment Interview Tool (Childhood Lead Poisoning Prevention Prog)
Childhood Lead Poisoning - 385
Electronic File
E09-13410
How Pica Affects a Pregnant Woman and her Unborn Baby/Como la Pica afecta A una mujer embarazada y
Blood Lead Epi - 863
Electronic File
E1-309
Lead in the Workplace and at Home / Plomo en el trabajo y la casa
Childhood Lead Poisoning - 386
Electronic File
Licensing & Regulation / Autorizacion y Reglamentacion F18-12059
Registration for State Mold Licensing Examination
Indoor Air Quality - 553
Forms
EF18-12059
Registration for State Mold Licensing Examination
PSQA-Envir Hazards - 365
Electronic File
Lungs & Respiratory System / Pulmones y el sistema respiratorio E9-202
Flu Fighters Activity Book / Luchadores contra la gripe librio de actividades
Communications - 872
Electronic File
E1-320
Things to Know about Cystic Fibrosis/Lo que debe saber sobre la fibrosis cistica
Newborn Screening - 68
Electronic File
9-202
Flu Fighters Activity Book / Luchadores contra la gripe librio de actividades
Warehouse
Coloring Books
Medicare/Medicaid / Medicare/Medicaid EEPSDT-26
Tips for Teens: Ways to Keep a Healthy Smile/Consejos para adolescentes: Como mantener una sonrisa
Oral Health - 597
Electronic File
MTP-410
Medicaid-Free Rides to the Doctor? (Pushcard)/Medicaid-Transporte gratis para al doctor?
Texas Health Steps - 24
Small card
MTP-310
Medicaid-Free Rides to the Doctor (poster)/Medicaid-Transporte gratis para al doctor?
Texas Health Steps - 24
Posters
E1-188
Introduction to Health Care Orientation / Orientacion a la Atencion Medica
Texas Health Steps - 284
Electronic File
E1-187
Welcome to Texas Health Steps Medicaid / Bienvenido a Medicaid de Pasos Sanos de Tejas!
Texas Health Steps - 284
Electronic File
CIHCP Form 100
CIHCP Application for Assistance (County Indigent)/Solicitud de Asistencia De Atencion Medica
Indigent Health Program 421
Electronic File
Medicine / Medicina ECM1-182
Case Management for Children and Pregnant Women / La administracion de casos para los ninos/mujeres
Texas Health Steps - 24
Electronic File
EPSDT-05
Checkups and a Whole Lot More / Chequeos-Y mucho, pero mucho mas!
Texas Health Steps - 24
Electronic File
E1-308
Lead in Your Food and Remedies / Plomo en su comida y en remedies caseros
Childhood Lead Poisoning - 386
Electronic File
E1-65
What is Phenylketonuria? / Que es la fenilcetonuria?
Newborn Screening - 281
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 182 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
Mental Retardation / Retraso mental E1-65
What is Phenylketonuria? / Que es la fenilcetonuria?
Newborn Screening - 281
Electronic File
Minority Health / Salud de minorias 13-183P
Posters
And Justice For All
Nursing / Enfermeria ECM1-182
Case Management for Children and Pregnant Women / La administracion de casos para los ninos/mujeres
Texas Health Steps - 24
Electronic File
Nutrition / Nutricion ENR-000-16
Treasure Hunt / Busqueda de un tesoro
Nutrition Services - 382
WIC Lesson/TrainingElectronic
EPB-000-01
Calci-yum / Calcio Delicioso
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-4
Smart Shopping Saves Money Using Unit Price Labels/Al comprar inteligentemente usted ahorra dinero
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ENR-000-13
Fad Diets / Dietas de moda
Nutrition Services - 382
WIC Lessons/Training
EGN-000-16
Fit Families: Portion Awareness / Las pocopmes correctas
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EGN-000-17
Fit Families: Smart Snacking / Bocadillos de primera
EGN-000-18
Grocery Shopping / Vamos al super
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EMN-000-14
Keen Eye on the Small Fry / Tres por el bein de los bebes
Nutrition Services - 417
WIC Lesson/TrainingElectronic
ENR-000-12
For Goodness Sake! Prevent Anemia / Por Favor! Prevenga la Anemia
Nutrition Services - 382
WIC Lesson/TrainingElectronic
EGN-000-15
Understanding Super-sized Portions / Entendiendo porciones tamano super
Nutrition Services - 414
WIC Lesson/TrainingElectronic
ENT-000-06
Folic Acid - What Every Woman Needs / El acido folico - lo que toda mujer necesita
Nutrition Services - 641
WIC Lesson/TrainingElectronic
EGN-000-13
Lily Does Lunch: Nutrition at Noon / Lily almuerza: la nutricion al medio dia (o en la comida)
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EPB-000-02
Add a Little Color to Your Life / Pongale un poco de color a su vida
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EPB-000-03
Help Yourself to Smaller Helpings / Sirvase raciones mas pequenas
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EPN-000-07
What Can I do Besides Eat?
Nutrition Services - 418
WIC Lesson/TrainingElectronic
ESP-000-02
Healthy Choices To Go / Selecciones saludables para llevar
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-12
Eat to Feel Healthy and Lose Weight/Coma para sentirse saludable y perder peso
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-18
Growing up from a Baby to a Toddler/El desarrollo de bebe a nino pequeno
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-3
Planning Your Meals / Planeando sus comidas
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ENR-000-15
What is So Big About Portion Size? / Tamano problema con las raciones
Nutrition Services - 382
WIC Lesson/TrainingElectronic
ECF-000-20
Tips for Making Grocery Shopping Pleasant / Consejos para que el viaje al supermercado sea agradable
Nutrition Services - 384
WIC Lesson/TrainingElectronic
13-06-11550
Did You Know - Children Need / Sabe Usted? Los ninos necesitan (poster)
Stock #4-25-lang Revised 10/25/2010
WIC Lesson/TrainingElectronic
Posters
Page 183 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
13-06-12053
Calci-yum Bulletin Board Borders (3 pcs) (Restricted to WIC Local Agencies)
Bulletin Board
13-06-12054
Calci-yum Bulletin Board Recipes Sheet 1 (Restricted to WIC Local Agencies)
Bulletin Board
13-06-12055
Calci-yum Bulletin Board Recipes Sheet 2 (Restricted to WIC Local Agencies)
Bulletin Board
13-06-12056
Calci-yum Bulletin Board (16 pcs) (Restricted to WIC Local Agencies)
Bulletin Board
ECF-000-08
Healthy and Tasty Cooking Demonstration-Family/Demonstracion de como cocinar platillos saludables
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECF-000-21
Healthy Drinks for Healthy Kids / Bebidas saludables para ninos saludables
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECH-000-20
Mealtime is Family Time: Mealtime Matters//Comer en familia:la hora de la comida es importante
Nutrition Services - 383
WIC Lesson/TrainingElectronic
EFE-000-05
Sally Gets Her Money's Worth: Economical Food Choices/Sally hace rendir su dinero
Nutrition Services - 728
WIC Lesson/TrainingElectronic
EFG-000-06
My Pyramid Simple Steps for Healthy Living
Nutrition Services - 643
WIC Lesson/TrainingElectronic
EGN-000-06
Say No to Fat/Grasa? No Grasa!
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EGN-000-08
Fruits and Vegetables, Lily Bets on 5 a Day/Las Frutas y los vegetales, Lily apuesta a cinco al dia
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EGN-000-09
Milk Comparison / Comparcion de leches
Nutrition Services - 414
WIC Lesson/TrainingElectronic
E13-06-13482
Easy to Be Gluten Free!
Nutrition Services - 884
Electronic File
Organ Donation / Donante de un organo (transplante de organo) F07-12808
Glenda Dawson Donate Life-Texas Registry Registration Form / Formulario de inscripcion en el registr
Donate Life Texas Registry - 718
Forms
EF07-12808
Glenda Dawson Donate Life-Texas Registry Registration Form / Formulario de inscripcion en el registr
Donate Life Texas Registry - 719
Electronic File
14-10
Donate Life / Done Vida (Texas DPS Poster) (limit 20)
Donate Life Texas Registry - 718
Posters
14-14
Donate Life / Done Vida (Texas Tax Assessor Poster) (limit 20)
Donate Life Texas Registry - 718
Posters
14-12
Donate Life / Done Vida (Texas General Market poster) (limit 20)
Warehouse
Posters
14-11
Donate Life / Done Vida (Information Card) (limit 1000 cards)
Warehouse
Small card
Parasites / Parasitos E05-12864
Head Lice Fact Sheet #1: What are Lice? / Que son los Piojos?
School Health Program 685
Electronic File
E05-12867
Head Lice Fact Sheet #4: How do I keep lice from coming back? / Como evito que vuelvan los piojos?
School Health Program 685
Electronic File
E05-12865
Head Lice Fact Sheet #2: How do I know if my child has head lice / Como se si mi hijo tiene piojos
School Health Program 685
Electronic File
E05-12868
Head Lice Fact Sheet #5: Myths, misconceptions, and truths about head lice treatments / Mitos, ideas
School Health Program 685
Electronic File
E05-12869
Head Lice Fact Sheet #6: Head Lice Resources / Recursos sobre los piojos de la cabeza
School Health Program 685
Electronic File
E1-29
Everything you need to know about Head Lice / Todo lo que debe saber sobre los piojos
School Health Program 685
Electronic File
E05-12866
Head Lice Fact Sheet #3: What Should I do if I think my child has head lice? / Que debo hacer si
School Health Program 685
Electronic File
Parenting / Crianza de los ninos 13-06-11622
Fit Families - First Steps
Stock #4-25-lang Revised 10/25/2010
Posters
Page 184 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format Posters
13-06-12261
Play with me (poster)
E08-13375
Texas Health Steps Checkups-Keeping Your Child Healthy / Los examenes de Pasos Sanos de Tejas
Texas Health Steps - 24
Electronic File
ESP-000-23
Cut Back on Screen Time/Acorte el tiempo frente a la pantalla
Nutrition Services - 420
WIC Lesson/TrainingElectronic
E13-133
Dad's Role in Supporting Breastfeeding / El rol del papa en el apoyo de la lactancia
Nutrition Services - 809
Electronic File
Patient/Client Records / Archivos de pacientes/clientes EL-30
Author to Release Confidential Info/Release of Medical Info (no print copy available)
Public Health Nursing - 263 Electronic File
Phenylketonuria (PKU) / Fenilcetonuria (PKU) E1-65
What is Phenylketonuria? / Que es la fenilcetonuria?
Newborn Screening - 281
Electronic File
Physical Fitness / Estado fisico EGD-000-06
Effortless Exercise / Ejercicio sin esfuerzo
Nutrition Services - 415
WIC Lesson/TrainingElectronic
ESP-000-28
Searching for a Rainbow-The Adventures of Zobey take home class/Buscando (limited-WIC local agencies
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EGD-000-07
The Adventures of Zobey: Searching for a Rainbow/Las Aventuras de Zobey
Nutrition Services - 415
WIC Lesson/TrainingElectronic
EGD-000-05
Get Active in Class with Zowzoo
Nutrition Services - 415
WIC Lesson/TrainingElectronic
EGD-000-02
Let's Get Our Bodies Moving! / Vamos a mover nuestros cuerpos!
Nutrition Services - 415
WIC Lesson/TrainingElectronic
EGD-000-01
Growing Healthy Families Through Physical Activity/Desarrollando familias saludables-actividad
Nutrition Services - 415
WIC Lesson/TrainingElectronic
13-06-11622
Fit Families - First Steps
ESP-000-13
Get Moving, Feel Great, Lose Weight/Mantengase activo, sientase estupendamente, pierda peso
Posters Nutrition Services - 420
WIC Lesson/TrainingElectronic
Poisons & Poisoning / Venenos e Intoxicaciones E1-310
My Child has a High Lead Level / Mi nino tiene un alto nivel de plomo
Childhood Lead Poisoning - 386
Electronic File
E1-311
How Lead Affects Your Child / Como dana el plomo a mi nino
Childhood Lead Poisoning - 386
Electronic File
E1-309
Lead in the Workplace and at Home / Plomo en el trabajo y la casa
Childhood Lead Poisoning - 386
Electronic File
E1-308
Lead in Your Food and Remedies / Plomo en su comida y en remedies caseros
Childhood Lead Poisoning - 386
Electronic File
E1-307
Lead Around the Home / Plomo alrededor de la casa
Childhood Lead Poisoning - 386
Electronic File
Prenatal & Postpartum Care / Cuidado prenatal y posparto EPN-000-06
Feeling Great Postpartum / Como sentirse de maravilla en el posparto
Nutrition Services - 418
WIC Lesson/TrainingElectronic
EMN-000-07
A Healthy Pregnancy / Un embarazo saludable
Nutrition Services - 417
WIC Lesson/TrainingElectronic
EMN-000-08
Pregnant and Growing / Embarazo y saludable
Nutrition Services - 417
WIC Lesson/TrainingElectronic
EMN-000-11
Your New Baby and Your Budget / Su nuevo bebe y su presupuesto
Nutrition Services - 417
WIC Lesson/TrainingElectronic
EMN-000-13
Being Active During and After Pregnancy/Como mantenerse aciva durante y despues del embarazo
Nutrition Services - 417
WIC Lesson/TrainingElectronic
EMN-000-15
A More Comfortable Pregnancy / Un Embarazo Mas Comodo
Nutrition Services - 417
WIC Lesson/TrainingElectronic
Stock #4-25-lang Revised 10/25/2010
Page 185 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EPN-000-03
Take Care of Your Baby's Best Friend / Cuide a la mejor amiga de su bebe
Nutrition Services - 418
WIC Lesson/TrainingElectronic
AVCD-0005
Newborn Screening: For Your Baby's Health Radio-- Public Service Announcements CDs (Limit 5)
Newborn Screening - 67
Compact Disks
Zoonosis - 376
Electronic File
Immunization - 293
Electronic File
Rabies and Animal Control / Rabia y control de animales E7-13
Rabies / La Rabia
Sexually Transmitted Diseases / Enfermedades de transmision sexual E11-13214
Fact Sheet Human Papillomavirus (HPV) / Hoja informativa Virus de papiloma humano (HPV)
Smoking & Smokeless Tobacco / Fumar y Tabaco sin humo ENR-000-11
Still Smoking? Lily Helps / Todavia fumas? Lily te ayuda
Nutrition Services - 382
WIC Lesson/TrainingElectronic
ESP-000-26
How does Secondhand Smoke affect my family/Como afecta a mi familia el humo de segunda
Nutrition Services - 420
WIC Lesson/TrainingElectronic
Texas Department of State Health Services / Departamento Estatal de Servicios de Salud de Texas E10-62
Breast and Cervical Cancer Services flyer/Cancer de mama y de cuello de utero servicios flyer
Breast & Cervical Cancer 749
Electronic File
E10-64
Breast and Cervical Cancer Services poster/Cancer de mama y de cuello de utero servicios cartel
Breast & Cervical Cancer 749
Electronic File
Weight Control / Control de peso ESP-000-13
Get Moving, Feel Great, Lose Weight/Mantengase activo, sientase estupendamente, pierda peso
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-12
Eat to Feel Healthy and Lose Weight/Coma para sentirse saludable y perder peso
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EPN-000-07
What Can I do Besides Eat?
Nutrition Services - 418
WIC Lesson/TrainingElectronic
EGD-000-03
Being Active as a Family / Manteniendos activos como una familia
Nutrition Services - 415
WIC Lesson/TrainingElectronic
EGN-000-15
Understanding Super-sized Portions / Entendiendo porciones tamano super
Nutrition Services - 414
WIC Lesson/TrainingElectronic
West Nile Virus / Virus del Nilo Occidental WN-Fact-Schools
West Nile Virus Fact Sheet for Schools / Hoja con informacion para escuelas
Zoonosis - 428
Electronic File
WN-Fact-Sheet
West Nile Virus Fact Sheet / Escrito de informacion general sobre los hechos del virus del Nilo occi
Zoonosis - 428
Electronic File
Women - Health & Hygiene / Mujeres--salud e higiene E10-64
Breast and Cervical Cancer Services poster/Cancer de mama y de cuello de utero servicios cartel
Breast & Cervical Cancer 749
Electronic File
E10-62
Breast and Cervical Cancer Services flyer/Cancer de mama y de cuello de utero servicios flyer
Breast & Cervical Cancer 749
Electronic File
1-451
A Woman's Right to Know Resource Directory / Directorio de Recursos (Limit 100)
Warehouse
Directories
13-06-12546
Women's Health Program Poster
Posters
Women, Infants, & Children Program / Programa de Nutricion Suplementaria para Mujeres, Bebes y Ninos EMN-000-08
Pregnant and Growing / Embarazo y saludable
Nutrition Services - 417
WIC Lesson/TrainingElectronic
EDH-000-05
Healthy Teeth, Part B / Dientes saludables, parte B
Nutrition Services - 639
WIC Lesson/TrainingElectronic
Stock #4-25-lang Revised 10/25/2010
Page 186 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
ECH-000-16
Let's Read "Growing Vegetable Soup"
Nutrition Services - 383
WIC Lesson/TrainingElectronic
EGD-000-01
Growing Healthy Families Through Physical Activity/Desarrollando familias saludables-actividad
Nutrition Services - 415
WIC Lesson/TrainingElectronic
EFS-000-02
Kitchen Food Safety-Fighting Bacteria/Seguridad en la cocina con los alimentos:combate la bacteria
Nutrition Services - 413
WIC Lesson/TrainingElectronic
EFG-000-06
My Pyramid Simple Steps for Healthy Living
Nutrition Services - 643
WIC Lesson/TrainingElectronic
EFE-000-05
Sally Gets Her Money's Worth: Economical Food Choices/Sally hace rendir su dinero
Nutrition Services - 728
WIC Lesson/TrainingElectronic
EGD-000-03
Being Active as a Family / Manteniendos activos como una familia
Nutrition Services - 415
WIC Lesson/TrainingElectronic
EDH-000-06
Nothing But the Tooth / Ana y la Dentista
Nutrition Services - 639
WIC Lesson/TrainingElectronic
EGD-000-04
Welcome to the Zowzoo Take Home Class/Bienvenido a la clase de Zowzoo
Nutrition Services - 415
WIC Lesson/TrainingElectronic
EDH-000-04
Healthy Teeth: A Guide for Parents of Preschoolers-Pt A/Dientes Saludables:Una guia para los padres
Nutrition Services - 639
WIC Lesson/TrainingElectronic
EDH-000-03
Take Time for Teeth / Tome tiempo para los dientes
Nutrition Services - 639
WIC Lesson/TrainingElectronic
ECH-000-20
Mealtime is Family Time: Mealtime Matters//Comer en familia:la hora de la comida es importante
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ECH-000-19
Let's Read "We Like to Nurse" / Nos gusta amamantar
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ECH-000-18
Let's Read "Breastfeeding Makes my Tummy Yummy" by Ceclia Moen
Nutrition Services - 383
WIC Lesson/TrainingElectronic
EBF-000-12
Infant Feeding Cues / Las senales de hambre en los recien nacidos
Nutrition Services - 412
WIC Lesson/TrainingElectronic
EF13-06-13185
Request for Breast Pump Assistance from the Texas WIC Program
Nutrition Services - 820
Electronic File
EGN-000-09
Milk Comparison / Comparcion de leches
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EIF-000-13
Formula Preparation / La preparacionde formula para bebes
Nutrition Services - 416
WIC Lesson/TrainingElectronic
EIF-000-10
Look Who's Eating / Miren quien esta comiendo
Nutrition Services - 416
WIC Lesson/TrainingElectronic
EGN-000-18
Grocery Shopping / Vamos al super
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EGN-000-17
Fit Families: Smart Snacking / Bocadillos de primera
EGN-000-16
Fit Families: Portion Awareness / Las pocopmes correctas
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EGD-000-02
Let's Get Our Bodies Moving! / Vamos a mover nuestros cuerpos!
Nutrition Services - 415
WIC Lesson/TrainingElectronic
EGN-000-13
Lily Does Lunch: Nutrition at Noon / Lily almuerza: la nutricion al medio dia (o en la comida)
Nutrition Services - 414
WIC Lesson/TrainingElectronic
ECH-000-15
Mammal-Baby Bingo
Nutrition Services - 383
WIC Lesson/TrainingElectronic
EGN-000-08
Fruits and Vegetables, Lily Bets on 5 a Day/Las Frutas y los vegetales, Lily apuesta a cinco al dia
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EGN-000-06
Say No to Fat/Grasa? No Grasa!
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EGD-000-08
The Adventures of Zobey: A Trip to Bugland (group)/ Las Aventuras de Zobey: un viaje a insectolandia
Nutrition Services - 415
WIC Lesson/TrainingElectronic
EGD-000-07
The Adventures of Zobey: Searching for a Rainbow/Las Aventuras de Zobey
Nutrition Services - 415
WIC Lesson/TrainingElectronic
Stock #4-25-lang Revised 10/25/2010
WIC Lesson/TrainingElectronic
Page 187 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
EGD-000-06
Effortless Exercise / Ejercicio sin esfuerzo
Nutrition Services - 415
WIC Lesson/TrainingElectronic
EGD-000-05
Get Active in Class with Zowzoo
Nutrition Services - 415
WIC Lesson/TrainingElectronic
EGN-000-15
Understanding Super-sized Portions / Entendiendo porciones tamano super
Nutrition Services - 414
WIC Lesson/TrainingElectronic
EBF-000-28
Breastfeeding Rummy / Juego de Rummy de la alimentacion con pecho
Nutrition Services - 412
WIC Lesson/TrainingElectronic
ECH-000-17
Let's Read "I Know an Old Lady Who Swallowed a Pie"
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ECF-000-06
Smart Snacking for Children / Bocadillos con estilo para ninos
Nutrition Services - 384
WIC Lesson/TrainingElectronic
EBF-000-33
A Mother's Gift / El regalo de una madre
Nutrition Services - 412
WIC Lesson/TrainingElectronic
EBF-000-32
How to Get Breastfeeding off to a Good Start/Como empezar la alimentacion con pecho correctamente
Nutrition Services - 412
WIC Lesson/TrainingElectronic
EBF-000-31
To Baby with Love: Overcoming Breastfeeding Barriers/Para me bebe con amor: superando las barreras
Nutrition Services - 412
WIC Lesson/TrainingElectronic
ECF-000-10
Don't Use Food as a Reward or Punishment/No use los alimentos como recompensa o castigo
Nutrition Services - 384
WIC Lesson/TrainingElectronic
EBF-000-29
Breastfeeding and Returning to Work/La alimentacion con pecho y el regreso al trabajo
Nutrition Services - 412
WIC Lesson/TrainingElectronic
ECF-000-11
Grocery Store Tour: Shopping for Healthy Snacks-Kids/Comprando bocadillos saludables para los ninos
Nutrition Services - 384
WIC Lesson/TrainingElectronic
EBF-000-27
Breast is Best:Scientifically Proven Benefits of Breastfeeding/La alimentacion con el pecho es mejor
Nutrition Services - 412
WIC Lesson/TrainingElectronic
EBF-000-23
A Mother's Guide to Breastfeeding / Guia materna para la alimentacion con el pecho
Nutrition Services - 412
WIC Lesson/TrainingElectronic
EBF-000-18
The Best Thing / Es lo Mejor
Nutrition Services - 412
WIC Lesson/TrainingElectronic
EBF-000-15
Teen Breastfeeding - Why Breastfeed? / Por que alimentar con el pecho?
Nutrition Services - 412
WIC Lesson/TrainingElectronic
EBF-000-14
The Best Investment / La mejor inversion
Nutrition Services - 412
WIC Lesson/TrainingElectronic
EBF-000-13
Helping Hand for Breastfeeding Moms / Mano de ayuda
Nutrition Services - 412
WIC Lesson/TrainingElectronic
EBF-000-30
Breastfeed: That's the Ticket / Alimentacion con pecho: asi se debe de hacer
Nutrition Services - 412
WIC Lesson/TrainingElectronic
ECF-000-22
Tips for Making Family Life Easier / Consejos para facilitar la vida familiar
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECH-000-14
Something Good for Babies / Algo bueno por los bebes
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ECH-000-13
Let's Read "D.W., The Picky Eater"/ Vamos a leer en casa: "D.W. tiene problemas para comer"
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ECH-000-12
Let's Read "Oliver's Vegetables" / Vamos a leer en casa: "Los vegetales de Oliver"
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ECH-000-11
Let's Read "Tops and Bottoms" / Vamos a leer en casa: "Los de arriba y los de abajo"
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ECH-000-10
Let's Read "Eating the Alphabet, Fruits & Vegetables" / Comiendo el alfabeto: frutas y vegatales
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ECF-000-08
Healthy and Tasty Cooking Demonstration-Family/Demonstracion de como cocinar platillos saludables
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECH-000-08
Let's Read "Lunch" / Vamos a leer en casa: "La comida"
Nutrition Services - 383
WIC Lesson/TrainingElectronic
EIF-000-16
Baby's First Spoonful: Tips for Starting Solids/El primer bocado de bebe: Consejos para introducir
Nutrition Services - 416
WIC Lesson/TrainingElectronic
Stock #4-25-lang Revised 10/25/2010
Page 188 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
ECF-000-21
Healthy Drinks for Healthy Kids / Bebidas saludables para ninos saludables
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECF-000-20
Tips for Making Grocery Shopping Pleasant / Consejos para que el viaje al supermercado sea agradable
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECF-000-19
Bring the Outside In / Traiga el exterior hacia el interior
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECF-000-18
Breakfast is for Champions / El desayuno es para campeones
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECF-000-17
Feeding Your Child 1-3 Years / Alimentando a su nino a los 1-3 anos
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECF-000-15
Childhood Obesity - Lily Faces a Problem / La obesidad en los ninos
Nutrition Services - 384
WIC Lesson/TrainingElectronic
ECH-000-09
Let's Read "Bread, Bread, Bread" / Vamos a leer en casa: "Pan, pan, pan"
Nutrition Services - 383
WIC Lesson/TrainingElectronic
ESP-000-19
Introducing Finger Foods/Como empezar a darle a su hijo alimentos que se comen con las manos
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EIF-000-14
Weaning from the Bottle / Dejando de tomar el biberon
Nutrition Services - 416
WIC Lesson/TrainingElectronic
ESP-000-28
Searching for a Rainbow-The Adventures of Zobey take home class/Buscando (limited-WIC local agencies
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-26
How does Secondhand Smoke affect my family/Como afecta a mi familia el humo de segunda
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-25
The Comfortable Latch Self-Paced Lesson / El agarre mas comodo (Restricted to WIC local agencies)
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-24
To Baby With Love: Overcoming Breastfeeding Barriers/Para el bebe con amor
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-3
Planning Your Meals / Planeando sus comidas
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-20
Weaning from the Bottle for Healthy Teeth and a Healthy Diet/Como quitarle el biberon al bebe para
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-4
Smart Shopping Saves Money Using Unit Price Labels/Al comprar inteligentemente usted ahorra dinero
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-18
Growing up from a Baby to a Toddler/El desarrollo de bebe a nino pequeno
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-16
You and Your Children Can Be Media Smart/Usted y sus hijos pueden estar conscientes de los efectos
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-15
Your Baby's Beautiful Teeth/Los hermosos dientes de su bebe
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-14
How Will You Feed Your New Baby?/Como alimentara usted a su nuevo bebe?
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-13
Get Moving, Feel Great, Lose Weight/Mantengase activo, sientase estupendamente, pierda peso
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-12
Eat to Feel Healthy and Lose Weight/Coma para sentirse saludable y perder peso
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-23
Cut Back on Screen Time/Acorte el tiempo frente a la pantalla
Nutrition Services - 420
WIC Lesson/TrainingElectronic
WIC-35-1A
Supplemental Information Form / Forma de informacion adicional
Nutrition Services - 885
Forms
WICR14
What to Bring to Your WIC Appointment / Lo que debe traer a su cita de WIC
Nutrition Services - 885
Forms
WICR02
Verification of Residency
Nutrition Services - 885
Forms
WIC-5
Notice of Participant Ineligibility
Nutrition Services - 885
Forms
WIC-45
Diet History for Pregnant/Breastfeeding/Postpartum Women/Historia medica para(restrict to Texas WIC)
Nutrition Services - 885
Forms
WIC-44
Health History for Children/Historia medica para ninos (restrict to Texas WIC)
Nutrition Services - 885
Forms
Stock #4-25-lang Revised 10/25/2010
Page 189 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
ESP-000-29
The Adventures of Zobey: A Trip to Bugland (home)/ Las Aventuras de Zobey: un viaje a insectolandia
Nutrition Services - 420
WIC Lesson/TrainingElectronic
WIC-35-3
WIC Income Questionnaire / Cuestionario del programa WIC sobre los ingresos
Nutrition Services - 885
Forms
ESP-000-08
Breastfeed Twins, Triplets or More / Alimentando con el pecho a gemelos, trillizos o mas?
Nutrition Services - 420
WIC Lesson/TrainingElectronic
WIC-26
Growing Healthy Families
Nutrition Services - 885
Forms
WIC-19A
Formulario para documentacion de ayuda de sustento / WIC Assistance Documentation Form
Nutrition Services - 885
Forms
F13-06-12042
EBT Participant Transfer Form (Restricted to WIC Local Agencies)
EWICR14
What to Bring to Your WIC Appointment / Lo que debe traer a su cita de WIC
Nutrition Services - 401
Electronic File
EWIC-34-6
Texas WIC Shopping Guide for Exclusively Breastfeeding Women
Nutrition Services - 824
Electronic File
EWIC-34-1
Shopping Guide for Formula Fed Infants
Nutrition Services - 824
Electronic File
WIC-42
Diet Health History for Infants/Historia de salud alimentaria para bebes (restrict to Texas WIC)
Nutrition Services - 885
Forms
EMN-000-13
Being Active During and After Pregnancy/Como mantenerse aciva durante y despues del embarazo
Nutrition Services - 417
WIC Lesson/TrainingElectronic
ENR-000-14
When Christina Got Smart-Preventing Diabetes and Heart Disease
Nutrition Services - 382
WIC Lesson/TrainingElectronic
ENR-000-13
Fad Diets / Dietas de moda
Nutrition Services - 382
WIC Lessons/Training
ENR-000-12
For Goodness Sake! Prevent Anemia / Por Favor! Prevenga la Anemia
Nutrition Services - 382
WIC Lesson/TrainingElectronic
ENR-000-11
Still Smoking? Lily Helps / Todavia fumas? Lily te ayuda
Nutrition Services - 382
WIC Lesson/TrainingElectronic
ENR-000-10
Diabetes Matters to Your Family/La diabetes es un tema importante para su familia
Nutrition Services - 382
WIC Lesson/TrainingElectronic
ESP-000-11
Weaning Your Baby From the Breast/Como dejar de alimentar con el pecho a su bebe
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EMN-000-14
Keen Eye on the Small Fry / Tres por el bein de los bebes
Nutrition Services - 417
WIC Lesson/TrainingElectronic
ENT-000-06
Folic Acid - What Every Woman Needs / El acido folico - lo que toda mujer necesita
Nutrition Services - 641
WIC Lesson/TrainingElectronic
EMN-000-12
Dental Health During Pregnancy / Salud dental durante el embarazo
Nutrition Services - 417
WIC Lesson/TrainingElectronic
EMN-000-11
Your New Baby and Your Budget / Su nuevo bebe y su presupuesto
Nutrition Services - 417
WIC Lesson/TrainingElectronic
EMN-000-09
New Baby Care: Keeping Your Baby Healthy and Happy / Cuidado del nuevo bebe: Manteniendo a su bebe
Nutrition Services - 417
WIC Lesson/TrainingElectronic
EIF-000-20
Fit Families: Baby Talk About Food/Familias en forma: Hablamos de la comida para babes
Nutrition Services - 416
WIC Lesson/TrainingElectronic
EIF-000-18
Watch Me Grow / Mira como crezco
Nutrition Services - 416
WIC Lesson/TrainingElectronic
EIF-000-17
Starting Solid Foods / Como empezar a dar alimentos solidos
Nutrition Services - 416
WIC Lesson/TrainingElectronic
EMN-000-15
A More Comfortable Pregnancy / Un Embarazo Mas Comodo
Nutrition Services - 417
WIC Lesson/TrainingElectronic
EPB-000-06
Breastfeeding-because your baby deserves the very best / Alimento con pecho
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EIF-000-15
Feeding Your Infant 8-12 Months / Alimentando a su bebe a los 8-12 meses
Nutrition Services - 416
WIC Lesson/TrainingElectronic
ESP-000-07
How to Breastfeed Your Newborn / Como alimentar a su recien nacido
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-06
A Helping Hand for Breastfeeding Moms/Una mano de ayuda para las mamas que estan alimentando
Nutrition Services - 420
WIC Lesson/TrainingElectronic
Stock #4-25-lang Revised 10/25/2010
Forms
Page 190 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
ESP-000-02
Healthy Choices To Go / Selecciones saludables para llevar
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ERB-000-14
Feed Your Child's Future / Alimente el futuro de su nino
Nutrition Services - 419
WIC Lesson/TrainingElectronic
EPN-000-07
What Can I do Besides Eat?
Nutrition Services - 418
WIC Lesson/TrainingElectronic
ENR-000-15
What is So Big About Portion Size? / Tamano problema con las raciones
Nutrition Services - 382
WIC Lesson/TrainingElectronic
EPN-000-03
Take Care of Your Baby's Best Friend / Cuide a la mejor amiga de su bebe
Nutrition Services - 418
WIC Lesson/TrainingElectronic
ENR-000-16
Treasure Hunt / Busqueda de un tesoro
Nutrition Services - 382
WIC Lesson/TrainingElectronic
EPB-000-05
Child's Play / Juego de ninos
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EPB-000-04
Beautiful Teeth, Beautiful Smile / Dientes hermosas para una sonrisa hermosa
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EPB-000-03
Help Yourself to Smaller Helpings / Sirvase raciones mas pequenas
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EPB-000-02
Add a Little Color to Your Life / Pongale un poco de color a su vida
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EPB-000-01
Calci-yum / Calcio Delicioso
Nutrition Services - 420
WIC Lesson/TrainingElectronic
ESP-000-1
Storing Leftovers Safely / Guarde las sobras para que no se echen a perder
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EPN-000-06
Feeling Great Postpartum / Como sentirse de maravilla en el posparto
Nutrition Services - 418
WIC Lesson/TrainingElectronic
13-06-12365-3
Child's Play Bulletin Board Take one and learn even more ways to play/Llevese uno y aprenda
E13-06-13482
Easy to Be Gluten Free!
13-06-11622
Fit Families - First Steps
Posters
13-06-12053
Calci-yum Bulletin Board Borders (3 pcs) (Restricted to WIC Local Agencies)
Bulletin Board
13-06-12054
Calci-yum Bulletin Board Recipes Sheet 1 (Restricted to WIC Local Agencies)
Bulletin Board
13-06-12055
Calci-yum Bulletin Board Recipes Sheet 2 (Restricted to WIC Local Agencies)
Bulletin Board
13-06-12217
Texas WIC.org (poster) (restricted to WIC Local Agencies)
Posters
13-06-11550
Did You Know - Children Need / Sabe Usted? Los ninos necesitan (poster)
Posters
EMN-000-07
A Healthy Pregnancy / Un embarazo saludable
13-06-12056
Calci-yum Bulletin Board (16 pcs) (Restricted to WIC Local Agencies)
Bulletin Board
13-45P
WIC is Growing Healthy Families (poster)
Posters
13-06-12261
Play with me (poster)
Posters
13-183P
And Justice For All
Posters
13-06-12408-6
Handouts and Client Questionnaire/ Hojas de informacion y cuestionario para clientes (limited distri
Bulletin Board
13-06-12546
Women's Health Program Poster
Posters
13-06-13394
Breastmilk: Every Ounce Counts (Baby) (Poster)
Posters
13-06-12804
My Goal/Mi Meta (stickers)
Stickers
13-06-12831
Breastfeeding Welcome Here / Aqui se permite amamantar (decal)
Decal
Stock #4-25-lang Revised 10/25/2010
Bulletin Board Nutrition Services - 884
Nutrition Services - 417
Electronic File
WIC Lesson/TrainingElectronic
Page 191 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E13-06-12907
Your Local Farmers Market
Nutrition Services - 805
Electronic File
E13-162
Breastfeeding Facts / Informacion sobre la lactancia materna (Restricted to WIC local agencies)
Nutrition Services - 809
Electronic File
E13-133
Dad's Role in Supporting Breastfeeding / El rol del papa en el apoyo de la lactancia
Nutrition Services - 809
Electronic File
Nutrition Services - 885
Forms
English/Spanish/Vietnamese Forms / Formularios WICR05
Infant Midpoint Review
Women, Infants, & Children Program / Programa de Nutricion Suplementaria para Mujeres, Bebes y Ninos Nutrition Services - 885
Forms
Case Management Case Transfer
Case Management - 309
Electronic File
CPW-13E-V
Case Management Client Satisfaction Survey
Case Management - 309
Electronic File
CPW-03E-V
Case Management Service Plan
Case Management - 309
Electronic File
CPW-07E-V
Case Management Referral Form
Case Management - 309
Electronic File
CPW-08E-V
Case Management Case Closure Form
Case Management - 309
Electronic File
WICR05
Infant Midpoint Review
English/Vietnamese Case Management / Administracion de casos CPW-09E-V
Children - Care & Hygiene / Ninos--su cuidado e higiene personal EPSDT-08A
THSteps Wallet Cards
Texas Health Steps - 24
Electronic File
EPSDT-05A
Checkups and a Whole Lot More
Texas Health Steps - 24
Electronic File
Immunization - 293
Electronic File
Nutrition Services - 803
Electronic File
Communicable Diseases / Enfermedades transmisibles E11-13210
Fact Sheet Haemophilus Influenzae type b (Hib / Hoja informativa Haemophilus Influenzae tipo b (Hib)
Forms / Formularios EWIC-19bV
Employment Verification Form (restricted to WIC Local Agencies)
WICR02V
Verification of Residency
EWIC-5V
Notice of Participant Ineligibility
Nutrition Services - 803
Electronic File
CPW-03E-V
Case Management Service Plan
Case Management - 309
Electronic File
CPW-08E-V
Case Management Case Closure Form
Case Management - 309
Electronic File
CPW-13E-V
Case Management Client Satisfaction Survey
Case Management - 309
Electronic File
CPW-09E-V
Case Management Case Transfer
Case Management - 309
Electronic File
CPW-07E-V
Case Management Referral Form
Case Management - 309
Electronic File
Immunization - 293
Electronic File
Forms
Immunization / Inmunizacion E11-13210
Fact Sheet Haemophilus Influenzae type b (Hib / Hoja informativa Haemophilus Influenzae tipo b (Hib)
Medicine / Medicina CM1-182A
Texas Health Steps Medical Case Management for Children and Pregnant Women Brochure
Texas Health Steps - 24
Electronic File
EPSDT-05A
Checkups and a Whole Lot More
Texas Health Steps - 24
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 192 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Nursing / Enfermeria CM1-182A
Texas Health Steps Medical Case Management for Children and Pregnant Women Brochure
Texas Health Steps - 24
Electronic File
Nutrition Services - 802
Electronic File
Prenatal & Postpartum Care / Cuidado prenatal y posparto E13-172V
A More Comfortable Pregnancy (Help for Common Problems During Pregnancy)
Texas Department of State Health Services / Departamento Estatal de Servicios de Salud de Texas CM1-182A
Texas Health Steps Medical Case Management for Children and Pregnant Women Brochure
Texas Health Steps - 24
Electronic File
Women, Infants, & Children Program / Programa de Nutricion Suplementaria para Mujeres, Bebes y Ninos EWIC-19bV
Employment Verification Form (restricted to WIC Local Agencies)
WICR02V
Verification of Residency
EWIC-5V
Notice of Participant Ineligibility
Nutrition Services - 803
Electronic File
Nutrition Services - 803
Electronic File
Forms
Mandarin Diabetes / Diabetes BCD VIDM
#Controlling Diabetes One Day at a Time (Limit 5)
Warehouse
Videocassette
10-21DVDM
Controlling Diabetes One Day at a Time (Limit 5)
Warehouse
DVD
Spanish Abortion / Aborto 1-451A
Descargar una copia del Directorio de Recursos del Derecho de la Mujer a la Informacion (max. 100)
Warehouse
Directories
TAC139.6(a)(2)
Linea de informacion gratuita (centro de aborto)
Abortion Facility Licensing - 634
Electronic File
E1-451A
Descargar una copia del Directorio de Recursos del Derecho de la Mujer a la Informacion
Perinatal/Maternal/Child 456
Electronic File
E1-450A
Descargar una copia del Material Informativo del Derecho de la Mujer a la Informacion
Perinatal/Maternal/Child 456
Electronic File
Childhood Lead Poisoning - 386
Electronic File
Accident Prevention & Safety / Prevencion de accidentes y Seguridad E1-26A
Proteja a sus ninos contra el envenenamiento de plomo (What Parents Need to Know About Lead Poison)
Adolescence / Adolescencia EB-104A
La vida puede ser dificil (Life Can Be Tough)
CMAP-Patient/Family Ed 654
Electronic File
EMH-10A
Los derechos de los adolescentes (Teen's Bill of Rights mental health)
Mental Hlth-Substance Abuse - 670
Electronic File
Vital Statistics - 745
Electronic File
Adoption / Adopcion E35-11068A
Informacion de adopcion en Texas y el Registro Central de Adopcion
AIDS/HIV / SIDA/VIH E4-158A
Debo hacerme una prueba de deteccion de VIH. Hoja informativa (Should I Get an HIV Test?)
HIV/STD - 332
Electronic File
13-13342A
InSpot Texas poster
HIV/STD - 44
Posters
InSpot Texas poster
HIV/STD - 332
Electronic File
E13-13342A
Stock #4-25-lang Revised 10/25/2010
Page 193 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
4-162A
Si tu has tenido sexo con dos personas (If you have Had Two Sex Partners) (Limit 50)
Warehouse
Posters
E4-141A
El VIH y el SIDA. Hechos que debe saber (HIV/AIDS: Facts You Should Know)
HIV/STD - 332
Electronic File
E4-151A
Informacion de examenes contra los anticuerpos de VIH. Justamente los hechos. (Antibody test)
HIV/STD - 332
Electronic File
E4-152A
Resultados negativos a la pruba del VIH. Hoja Informativa (Negative HIV Antibody Tests)
HIV/STD - 332
Electronic File
E4-153A
Prueba positiva de anticuerpos del VIH. Hoja informativa (Positive antibody test)
HIV/STD - 332
Electronic File
E13-13343A
InSpot Texas palm card
HIV/STD - 332
Electronic File
E4-206A
10 preguntas sobre el embarazo y el VIH (10 Questions About Pregnancy and HIV)
HIV/STD - 332
Electronic File
E4-213A
Y en cuanto a sus parejas? (What About Your Partners) (Partner Notification)
HIV/STD - 332
Electronic File
EJ-6A
Disclosure and Consent for HIV
HIV/STD - 734
Electronic File
E13-11908A
El riesgo de comer ostiones crudos (Risk of Eating Raw Oysters)
HIV/STD - 449
Fact Sheets
E4-218A
El Programa de Texas para Medicanmentos contra el VIH (Texas HIV Medication Program)
HIV/STD - 332
Electronic File
CMAP-Patient/Family Ed 655
Electronic File
Attention Disorder / Trastorno de Atencion EB-106A
Tiene me Nino(a) un Trastorno de Atencion? (Does My Child Have an Attention Disorder?)
Bioterrorism / Bioterrorismo E19-12070A
La tularemia y bioterrorismo (Tularemia and Bioterrorism)
External Relations Communications - 590
Electronic File
E19-12069A
La viruela y bioterrorismo (Smallpox and Bioterrorism)
External Relations Communications - 590
Electronic File
E19-12068A
La peste y bioterrorismo (Plague and Bioterrorism)
External Relations Communications - 590
Electronic File
E19-12067A
El botulismo y bioterrorismo (Botulism and Bioterrorism)
External Relations Communications - 590
Electronic File
E19-12066A
La preparacion y respuesta contra el bioterrismo (Bioterrorism Preparedness and Response)
External Relations Communications - 590
Electronic File
E19-12065A
El anthrax y bioterrorismo (Anthrax and Bioterrorism)
External Relations Communications - 590
Electronic File
E11-11161A
Vacuna contra el carbunco (Antrax)-Lo que usted necesita saber (Anthrax Vaccine-VIS)
Immunization - 41
Electronic File
E19-12071A
La fiebre viral hemorragica y bioterrorismo (Viral Hemorrhagic Fevers and Bioterrorism)
External Relations Communications - 590
Electronic File
Birth Certificates & Vital Statistics / Actas de nacimiento y Estadisticas vitales FVS-109A.1
Hoja de trabajo de la madre sobre el acta de nacimiento de su criatura (Mother's worksheet)
Vital Statistics - 71
Forms
EFVS-109A.1
Hoja de trabajo de la madre sobre el acta de nacimiento de su criatura (Mother's worksheet)
Vital Statistics - 758
Electronic File
Epidemiology/Injury Surveillance - 351
Electronic File
Nutrition Services - 809
Electronic File
Brain Injury / Lesion cerebral E07-11640A
Los importantes primeros pasos para apoyar a un ser querido que padece una lesion cerebral
Breastfeeding / Alimentacion con pecho E13-06-13331A
La Lactancia materna despues de los 6 meses
13-186A
Pregunte Sobre Nuestro Programa de WIC
Stock #4-25-lang Revised 10/25/2010
Posters
Page 194 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information) Forms
WIC-51A
Formulario de absolucion para el uso de las bombas extractoras electrica a plazo corto (Restricted)
E13-101A
La alimentacion con pecho y la planificacion familiar (Breastfeeding and Family Planning)
Nutrition Services - 809
Electronic File
E13-102A
Dale a tu Bebe el mejor Cominezo
Nutrition Services - 570
Electronic File
E13-206A
Como sacar la leche materna a mano y como guardarla (Hand Expression and Storage of Breastmilk)
Nutrition Services - 809
Electronic File
E13-184A
La Leche materna: mas que solo un alimento (Mother's Milk: It's More Than Just Food)
Nutrition Services - 570
Electronic File
E13-06-13181A
Promueva la lactancia materna Sea una consejera companeras de WIC Enriquezca la vida de los demas
Nutrition Services - 809
Electronic File
13-06-13404A
Se permite amamantar bienvenida (window clings) (restricted to WIC Local Agencies)
Window clings
13-06-12408-5A
Alimentar con pecho es conveniente (Restricted to WIC Local Agencies)
Bulletin Board
13-06-12408-4A
Peinsa regresar al trabajo o a la escuela? (Restricted to WIC Local agencies)
Bulletin Board
E13-46A
Leche materna para bebes prematuros (Mother's Milk For Premature Babies)
Nutrition Services - 570
Electronic File
E13-53A
Solo para el papa (Just for Dad)
Nutrition Services - 809
Electronic File
E13-179A
Alimentar con pecho en publico
Nutrition Services - 809
Electronic File
E13-06-12038A
Como se si estoy produciendo suficiente leche? (How Do I Know if I am Making Enough Milk?)
Nutrition Services - 570
Electronic File
13-25-1A
Boy Crib Card
Nutrition Services - 885
Small card
13-25-2A
Girl NICU Crib Card
Nutrition Services - 885
Small card
E13-06-13120A
Su estancia en el hospital: que esperar y como hacerla inolvidable (The Hospital Experience: What to
Nutrition Services - 809
Electronic File
13-25-3A
Boy NICU Crib Card
Nutrition Services - 885
Small card
13-25A
Girl Crib Card
Nutrition Services - 885
Small card
E13-58A
Un Lugar de Trabajo que Apoya a las Mamas (Become a MotherFriendly Worksite)
Nutrition Services - 809
Electronic File
E13-06-10954A
Guia de instrucciones para darle a su bebe lo mejor (Instructional Guide for Giving Your Baby)
Nutrition Services - 570
Electronic File
E13-06-11934A
Soy un papa orgulloso (I'm A Proud Dad) (poster)
Nutrition Services - 570
Electronic File
E13-06-11496A
Amamantar y trabajar - si se puede (Breastfeeding and Working Works for Me-brochure)
Nutrition Services - 809
Electronic File
E13-06-11288A
Especialmente para los abuelos (Just For Grandparents)
Nutrition Services - 809
Electronic File
E13-06-11342A
Manual de dar pecho para las consejeras companeras de WIC
Nutrition Services - 150
Electronic File
E13-06-11289A
Alimentando con el pecho a mas de un un bebe (Nursing More Than One)
Nutrition Services - 570
Electronic File
E13-06-13182A
El apoyo que usted necesita Consejeras companeras de WIC para amamantar con exito
Nutrition Services - 809
Electronic File
13-06-12408-11A
Encuestra de la leccion sobre la lactnacia maternal (Restricted to WIC Local agencies)
EWIC-50A
Formulario de absolucion para el uso de las bombas extractoras electrica a plazo largo
13-06-11934A
Soy un papa orgulloso (I'm A Proud Dad) (poster)
Posters
13-06-12408-2A
Su bebe puede digerir la leche maternal (Restricted to WIC Local agencies)
Bulletin Board
13-06-12408-12A
Dele un buen comienzo a la lactancia (Restricted to WIC Local agencies)
Bulletin Board
Stock #4-25-lang Revised 10/25/2010
Bulletin Board Nutrition Services - 307
Electronic File
Page 195 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
13-06-12233A
Como saber si su recien nacido esta tomando suficiente leche materna(Restrict to WIC Local Agencies)
EWIC-51A
Formulario de absolucion para el uso de las bombas extractoras electrica a plazo corto
13-06-12287A
Breastmilk: 100% Natural Ingredients (Bib) (restricted to WIC Local Agencies)
Magnets Nutrition Services - 307
Electronic File Infant Bib
F13-06-13103A
Registro de uso del sacaleches (Breast Pumping Log)
Forms
WIC-50A
Formulario de absolucion para el uso de las bombas extractoras electrica a plazo largo (Restricted)
Forms
13-06-12408-3A
Alimentar con pecho es bueno para la salud de las mamas (Restricted to WIC Local agencies)
Bulletin Board
Cancer / Cancer E10-53A
Vivir con su propla decision (Living With Your Own Decision: Facts about Prostate Cancer Screening)
Adult Health - 231
Electronic File
Case Management - 309
Electronic File
Case Management / Administracion de casos CPW-12S
Autorizacion para divulgar la informacion confidencial (Case Management)
Child Development / Desarrollo infantil E1-66A
Con Que Su Bebe Tiene El Rasgo de Globulos Falciformes (So Your Baby Has the Sickle Cell Trait)
Newborn Screening - 313
Electronic File
E05-05015A
Hipotiroidismo Y Su Infante (Hypothyroidism and Your Infant)
Newborn Screening - 317
Electronic File
Childbirth / Parto F66-10715A
Midwife - Newborn Screening Test Objection Form
Midwifery Program - 124
Forms
F66-10717A
Midwife Informed Choice and Disclosure Statement
Midwifery Program - 124
Forms
Children - Care & Hygiene / Ninos--su cuidado e higiene personal EPSDT-15S
La administracion de casos para los ninos y las mujeres embarazadas (Poster) 8-1/2" x 11"
Texas Health Steps - 24
Electronic File
EPSDT-13S
Citas con su medico y dentista (Appointments Education Poster) (16" x 20")
Texas Health Steps - 24
Electronic File
13-06-12579A
Zobey Magnet: Sabe usted los ninos necesitan (Restricted to WIC local agencies)
E59-11511A
Guia para los padres-Use los antibioticos en forma inteligente (GuideGet Smart about Antibiotics)
Infectious Disease - 638
Electronic File
E59-11766A
Centros de Atencion Diurna y Padres de Familia - sobre las infecciones estafilococicas
Infectious Disease - 638
Electronic File
E1-206A
Hiperplasia Adrenal Congenita: Libro de Informacion para los Padres (Congenital Adrenal Hyperplasia)
Newborn Screening - 282
Electronic File
E59-11765A
Administradores de Atencion Diurna sobre las infecciones estafiolococicas
Infectious Disease - 638
Electronic File
Magnets
Posters
13-06-12262A
Hey Look What I can Do (poster)
EPSDT-12S
Chequeos-Pasos Sanos de Tejas (Checkups Poster -Texas Health Steps)
Texas Health Steps - 24
Electronic File
E05-03876A
Infeccion Neumococica y Penicilina (Pneumococcal Infection and Penicillin)
Newborn Screening - 313
Electronic File
Children - Nutrition / Ninos--su nutricion E05-10822A
Tarjeta Del Alimento De Galactosemia (Galactosemia Food Card)
Newborn Screening - 318
Electronic File
E40465
Creando Familias Sanas (Building Healthy Families)
Communications- 517
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 196 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Children with Special Needs / Programa para ninos con necesidades especiales E07-13111A
Lista de recursos para jovenes en transicion en Tejas (Resource List for Transitioning Youth in Tex)
Children w/Special Health Care Needs - 797
Electronic File
E4-1A
Programa de Servicios CSHCN (brochure)
Children w/Special Health Care Needs - 682
Electronic File
07-12617A
Programa de Servicios CSHCN (CSHCN Services Program Poster)
Children w/Special Health Care Needs - 681
Posters
E07-12153A
Que es un hogar medico? (What is a Medical Home?) (Medical Home Brochure)
Children w/Special Health Care Needs - 512
Electronic File
E19-12148A
Para Detener el Contagio de los Resfriados y la Gripe (Stop the Spread of Colds and Flu)
Communications - 510
Electronic File
E59-12227A
Catarro o Gripe (Cold or Flu?)
Infectious Disease - 638
Electronic File
Colds / Resfrios
Communicable Diseases / Enfermedades transmisibles E59-11767A
Atletas Escolares Informacion sobre infecciones estafilococicas para el atleta
Infectious Disease - 638
Electronic File
E59-11765A
Administradores de Atencion Diurna sobre las infecciones estafiolococicas
Infectious Disease - 638
Electronic File
E59-11874A
Ciclospora Hoja de Informacion (Cyclospora Fact Sheet)
Infectious Disease - 184
Electronic File
E59-11766A
Centros de Atencion Diurna y Padres de Familia - sobre las infecciones estafilococicas
Infectious Disease - 638
Electronic File
E59-11768A
Departamentos Atleticos Escolares sobre las infecciones estafilococicas
Infectious Disease - 638
Electronic File
E19-12069A
La viruela y bioterrorismo (Smallpox and Bioterrorism)
External Relations Communications - 590
Electronic File
C-85A
Vacuna Neumococica conjugada-Lo que usted necesita saber (Pneumococcal Conjugate Vaccine)
Immunization - 710
Forms
C-91A
Vacunas Difteria, Tetanos, y Tos Ferina-lo que usted necesita saber (Tetanus, Diphtheria and Pertus)
Immunization - 710
Forms
CD-001A
Medicamento Como Terapia Para el Tratamiento de la Enfermedad de Hansen
Hansen's Disease - 83
Forms
E05-03876A
Infeccion Neumococica y Penicilina (Pneumococcal Infection and Penicillin)
Newborn Screening - 313
Electronic File
E11-11530A
Es solamente una tos? O mas bien es la pertussis (tos ferina)? (Pertussis brochure)
Immunization - 781
Electronic File
E11-12811A
A los ninos pequenos tambien les da la gripe (Little Kids Get theFlu Too)
Immunization - 781
Electronic File
E5-100A
Conciencia soble la higiene contra el SARM (MRSA Hygiene Awareness)
Infectious Disease - 400
Electronic File
E19-12065A
El anthrax y bioterrorismo (Anthrax and Bioterrorism)
External Relations Communications - 590
Electronic File
E59-11324A
La infeccion Invasora con Estreptococo de Grupo A (Invasive Group A Streptococcus)
Infectious Disease - 184
Electronic File
E19-12148A
Para Detener el Contagio de los Resfriados y la Gripe (Stop the Spread of Colds and Flu)
Communications - 510
Electronic File
E19-12368A
Lo que usted necesita saber la influenza aviar (What You Need to Know about Avian Influenza)
External Relations Communications - 610
Electronic File
E19-12369A
Lo que usted necesita saber sobre la influenza y la influenza pandemica
External Relations Communications - 610
Electronic File
E19-12380A
Influenza Pandemica los puntos clave (Pandemic Flu Key Points)
External Relations Communications - 610
Electronic File
E6-5A
Impetigo
Infectious Disease - 184
Electronic File
E5-200A
Cubra su tos (Cover Your Cough)
Infectious Disease - 602
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 197 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
5-13PA
El tomar una buena ofensiva aun es la mejor defensa! (A Good Offense is Still the Best Defense)
Warehouse
Posters
E6-7A
Criptosporidiosis (Cryptosporidiosis)
Infectious Disease - 184
Electronic File
ECD-010A
Biopsia de la Piel para Casos o Sospechosos de la Enfermedad de Hansen
Infectious Disease - 629
Electronic File
ECD-001A
Medicamento Como Terapia Para el Tratamiento de la Enfermedad de Hansen
Infectious Disease - 629
Electronic File
EC-84A
2009 H1N1 Inactivated Influenza Vaccine - What You Need to Know (VIS)
Immunization - 41
Electronic File
E7-7A
Encefalitis (Encephalitis)
Zoonosis - 376
Electronic File
E7-36A
Informacion Sobre La Peste (Facts About Plague)
Zoonosis - 376
Electronic File
E59-12227A
Catarro o Gripe (Cold or Flu?)
Infectious Disease - 638
Electronic File
7-38A
Aviso Sobre la Peste (Plague Warning) (poster)
Warehouse
Posters
E59-12490A
Preguntas Y Respuestas Infecciones de la piel por Staphylococcus aureus resistentes a los antibiotic
Infectious Disease - 703
Electronic File
E59-12229A
Lo Que Usted Debe Saber Acerca del uso del antibioticos(What You Should Know about using Antibiotics
Infectious Disease - 638
Electronic File
E59-12228A
Que Hacer y No Que Hacer en el uso de antibioticos (Antibiotic Use Do's and Don'ts)
Infectious Disease - 638
Electronic File
Community & Rural Health / Salud en la comunidad y Salud rural F21-13512A
Solicitud de Renovacion del Certificado del Promotor(a) de Salud
Community Hlth Wrkr 370
Forms
EF21-13512A
Solicitud de Renovacion del Certificado del Promotor(a) de Salud
Community Hlth Wrkr 371
Electronic File
EF21-13513A
Solicitud de Renovacion del Certificado del Instructor(a)
Community Hlth Wrkr 371
Electronic File
F21-13510A
Solicitud para la Certificacion del Promotor(a) de Salud (Application)
Community Hlth Wrkr 370
Forms
E79-10929A
Estudio Sobre Salud y Condicion del Medio Ambiente de los Municipios/Colonias de la Frontera/Texas
Office of Border Health 583
Electronic File
F21-13511A
Solicitud para la Certificacion del Instructor(a) (Application)
Community Hlth Wrkr 370
Forms
EF21-13511A
Solicitud para la Certificacion del Instructor(a) (Application)
Community Hlth Wrkr 371
Electronic File
F21-13513A
Solicitud de Renovacion del Certificado del Instructor(a)
Community Hlth Wrkr 370
Forms
EF21-13510A
Solicitud para la Certificacion del Promotor(a) de Salud (Application)
Community Hlth Wrkr 371
Electronic File
Epidemiology/Injury Surveillance - 351
Electronic File
Children w/Special Health Care Needs - 512
Electronic File
EMS - 722
Electronic File
Concussion / Conmocion E07-11640A
Los importantes primeros pasos para apoyar a un ser querido que padece una lesion cerebral
Consumer Health / Salud del consumidor E07-12153A
Que es un hogar medico? (What is a Medical Home?) (Medical Home Brochure)
Death & Dying / La muerte y el morirse EF01-11421A
Department of State Health Services Standard Out-of-Hospital Do Not Resuscitate Order (DNR)
Dental Health / Salud dental E08-12876A
Guia de ensenanza sobre la salud dental
Oral Health - 597
Electronic File
08-10255
Sugestiones beneficiosas para mantenar dientes saludables de su Hijo (cartel) (Helpful Hints-poster)
Oral Health - 256
Posters
Stock #4-25-lang Revised 10/25/2010
Page 198 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
8-20S
Tomar Tiempo Para Los Dientes (Take Time for Teeth Flipchart maximum 10)
Oral Health - 597
Flip Charts
EPSDT-10S
Dedique que tiempo a los dientes (Take Time for Teeth) Poster (16" x 20")
Texas Health Steps - 24
Electronic File
Depression / Depresion EB-104A
La vida puede ser dificil (Life Can Be Tough)
CMAP-Patient/Family Ed 654
Electronic File
F105-12317A
Hoja de sintomas y efectos secundarios-La depresion (Symptoms/side effects: Depression)
TIMA-Patient/Family Ed 585
Forms
EF105-12317A
Hoja de sintomas y efectos secundarios-La depresion (Symptoms/side effects: Depression)
TIMA-Patient/Family Ed 586
Electronic File
B-103A
Kris, Estas Triste? (Kris, Are You Sad?) (Limit 1)
Warehouse
Coloring Books
EB-103A
Kris, Estas Triste? (Kris, Are You Sad?) (coloring book)
CMAP-Patient/Family Ed 654
Electronic File
EB-102A
La depresion (Brain Function Sheet: Depression)
TIMA-Patient/Family Ed 586
Electronic File
E105-12319A
La depresion (Medication Benefit Sheet: Depression)
TIMA-Patient/Family Ed 586
Electronic File
EB-105A
La mayoria de los ninos(as) que estan deprimidos no le diran sise sienten triste (Most children)
CMAP-Patient/Family Ed 654
Electronic File
B-102A
La depresion (Brain Function Sheet: Depression) (Limit 1)
Warehouse
Fact Sheets
Diabetes / Diabetes E10-27A
Podria usted tener diabetes? (Cuestionario) Could You Have Diabetes?
Texas Diabetes Council 375
Electronic File
E10-28A
Viviendo con la diabetes (Una guía) (Living With Diabetes)
Texas Diabetes Council 375
Electronic File
E10-24A
Comer para vivir: Como vivir bien con diabetes (Food for LifeLiving Well With Diabetes)
Texas Diabetes Council 375
Electronic File
10-26A
Si usted tiene diabetes por favor quitese los zapatos y los calcetines (Limit 100)
Warehouse
Posters
BCD-DVDS
Controlling Diabetes One Day at a Time (Limit 5)
Warehouse
DVD
BCD VIDS
#Controlling Diabetes One Day at a Time (Limit 5)
Warehouse
Videocassette
Disabilities & the Disabled / Discapacidades y Personas discapacitadas E05-10004A
El CAHOOT (The CAHOOT Newsletter)
Newborn Screening - 282
Electronic Newsletter/Magazine
05-10004A
El CAHOOT (The CAHOOT Newsletter) (Limit 5)
Newborn Screening - 67
Newsletters
Que es un hogar medico? (What is a Medical Home?) (Medical Home Brochure)
Children w/Special Health Care Needs - 512
Electronic File
Rohypnol y Los Adolescentes (Teens and Rohypnol poster)
HSR 9/10 - 287
Posters
Es Contra La Ley (It is Against the Law) (Rohypnol)
HSR 9/10 - 287
Posters
E07-12153A
Drugs / Drogas y farmacos Rohypnol-1A Rohypnol-2A
Ears & Hearing Disorders / Oidos y Trastornos de audicion E1-84A
Cuestionario del Oidio
PACT-Health Steps - 778
Electronic File
E1-84S
Los Sonidos de Texas-Los Puede Oir Su Bebe? (Sounds of Texas)
Texas Health Steps - 24
Electronic File
Emergency Preparedness / Preparacion ante emergencias E19-12247A
Lo que usted necesita saber sobre Calor (What you need to know about Heat)
External Relations Communications - 545
Electronic File
E19-12246A
Lo que usted necesita saber sobre..Al regresar a un edificio que se inundo (what you need to know
External Relations Communications - 545
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 199 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
E19-12245A
Lo que usted necesita saber sobre..Las inundaciones y las enfermedades diarrecias (What you need to
E19-12244A
Lo que usted necesita saber sobre Las inundaciones (What you need to know about floods)
External Relations Communications - 545
Format Electronic File Electronic File
Emergency Services / Servicios de emergencia E1-26A
Proteja a sus ninos contra el envenenamiento de plomo (What Parents Need to Know About Lead Poison)
Childhood Lead Poisoning - 386
Electronic File
EF01-11421A
Department of State Health Services Standard Out-of-Hospital Do Not Resuscitate Order (DNR)
EMS - 722
Electronic File
Emotions / Emociones EB-104A
La vida puede ser dificil (Life Can Be Tough)
CMAP-Patient/Family Ed 654
Electronic File
EB-103A
Kris, Estas Triste? (Kris, Are You Sad?) (coloring book)
CMAP-Patient/Family Ed 654
Electronic File
EB-105A
La mayoria de los ninos(as) que estan deprimidos no le diran sise sienten triste (Most children)
CMAP-Patient/Family Ed 654
Electronic File
B-103A
Kris, Estas Triste? (Kris, Are You Sad?) (Limit 1)
Warehouse
Coloring Books
Environmental Health / Salud ambiental EF09-11927A
Exposicion a los pesticidas por los humanos
Pesticide Exposure Surv (PEST) - 452
Electronic File
E18-12049A
Hoja de informacion para el usuario sobre el moho (Consumer Mold Information Sheet)
PSQA-Envir Hazards - 365
Electronic File
E79-10929A
Estudio Sobre Salud y Condicion del Medio Ambiente de los Municipios/Colonias de la Frontera/Texas
Office of Border Health 583
Electronic File
E09-12821A
Los pesticidas en su camino (Pesticides in Your Path)
Pesticide Exposure Surv (PEST) - 452
Electronic File
Nutrition Services - 809
Electronic File
External Relations Communications - 545
Electronic File
Family Planning / Planificacion familiar E13-101A
La alimentacion con pecho y la planificacion familiar (Breastfeeding and Family Planning)
First Aid / Primeros auxilios E19-12247A
Lo que usted necesita saber sobre Calor (What you need to know about Heat)
Food Safety & Hygiene / Seguridad alimenticia e Higiene E13-11908A
El riesgo de comer ostiones crudos (Risk of Eating Raw Oysters)
HIV/STD - 449
Fact Sheets
E25-12785A
Empleado obligado a lavarse las manos (Employees Must Wash Hands Before Returning to Work)
Food Establishments - 713
Electronic File
E19-12067A
El botulismo y bioterrorismo (Botulism and Bioterrorism)
External Relations Communications - 590
Electronic File
E19-12248A
Lo que usted necesita saber sobre..enfermedades transmitidas por alimentos (What you need to know
External Relations Communications - 545
Electronic File
23-13297A
Atension empleados alimentarios
Food Establishments - 810
Posters
E23-13297A
Atension empleados alimentarios
Food Establishments - 713
Electronic File
E23-12786A
Temperaturas recomedadas para los alimentos (Recommended Safe Food Temperatures)
Food Establishments - 713
Electronic File
EF23-13281A
Formulario: 1-A Entrevista de empleados condicionales y empleados alimentarios
Food Establishments - 811
Electronic File
E23-12785A
Los Empleados se deben lavar las manos antes de volver al trabajo (handwash poster)
Food Establishments - 713
Electronic File
E23-12787A
Doble Lava Manos (Double Handwash poster)
Food Establishments - 713
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 200 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Forms / Formularios FVS-109A.1
Hoja de trabajo de la madre sobre el acta de nacimiento de su criatura (Mother's worksheet)
Vital Statistics - 71
EL-29A
Referral Form Instructions (no print copy available)
Public Health Nursing - 263 Electronic File
G-1B-Span
Formulario de remision de muestras-Quimica clinica y Estudios del AND
Labs - 388
Forms
EWIC-35-3A
Cuestionario del programa WIC sobre los ingresos (WIC Income Questionnaire)
Nutrition Services - 401
Electronic File
TB-415A
Formulario de consentimiento tratamiento para la infección de tuberculosis latente
Warehouse
Forms
F41-11811A
Solicitud Para Asistencia (Hemophilia Assistance-Application for Assistance-Adults over 21)
Hemophilia Assistance 403
Forms
F21-13513A
Solicitud de Renovacion del Certificado del Instructor(a)
Community Hlth Wrkr 370
Forms
EFVS-109A.1
Hoja de trabajo de la madre sobre el acta de nacimiento de su criatura (Mother's worksheet)
Vital Statistics - 758
Electronic File
G-1C-Span
Exam sistematico triple prenatal del suero materno
Labs - 388
Forms
G-2A-Span
Formulario de remision de muestras-Serologia y virologia
Labs - 388
Forms
G-2B-Span
Formulario de remision de muestras-bacteriologia y parasitologia
Labs - 388
Forms
F21-13512A
Solicitud de Renovacion del Certificado del Promotor(a) de Salud
Community Hlth Wrkr 370
Forms
TB-411A
Formulario de declaraciones y aceptacion tratamiento de la tuberculosis
Warehouse
Forms
TB-619
Registro de Tratamiento (Treatment Record)
Infectious Disease Control Unit - TB - 253
Forms
TB-620
Registro de Tratamiento Preventivo (Preventive Treatment Record)
Infectious Disease Control Unit - TB - 253
Forms
WIC-35-3A
Proof of Income (WIC)
Nutrition Services - 885
Forms
WIC-50A
Formulario de absolucion para el uso de las bombas extractoras electrica a plazo largo (Restricted)
Forms
WIC-51A
Formulario de absolucion para el uso de las bombas extractoras electrica a plazo corto (Restricted)
Forms
KHC-3A
Formulario para cobros de transportacion (Kidney Health Care Transportation Claim Form)
F13-06-13103A
Registro de uso del sacaleches (Breast Pumping Log)
EWIC-42A
Historia de salud alimentaria para bebes
Nutrition Services - 730
Electronic File
EWIC-44A
Historia medica para ninos (Health History for Children)
Nutrition Services - 730
Electronic File
EWIC-45A
Historia medica para jujeres embarazadas/pospartos/que amamantan
Nutrition Services - 730
Electronic File
EWIC-50A
Formulario de absolucion para el uso de las bombas extractoras electrica a plazo largo
Nutrition Services - 307
Electronic File
EWIC-51A
Formulario de absolucion para el uso de las bombas extractoras electrica a plazo corto
Nutrition Services - 307
Electronic File
EWIC-35-1A
Forma de informacion adicional Oportunidad de registrarse para votar-Forma NVRA-WIC
Nutrition Services - 401
Electronic File
F07-12808A
Formulario de inscripcion en el registro de Texas Glenda Dawson Done Vida
Donate Life Texas Registry - 718
Forms
F105-12316A
Hoja de sintomas y efectos secundarios-La Esquizofrenia (Symptoms/side effects: Schizophrenia)
TIMA-Patient/Family Ed 585
Forms
F105-12317A
Hoja de sintomas y efectos secundarios-La depresion (Symptoms/side effects: Depression)
TIMA-Patient/Family Ed 585
Forms
F105-12318A
Hoja de sintomas y efectos secundarios-La mania (Symptoms/side effects: Bipolar Disorder)
TIMA-Patient/Family Ed 585
Forms
Stock #4-25-lang Revised 10/25/2010
Kidney Health Care - 179
Forms
Forms Forms
Page 201 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
F11-11755A
Declaracion jurada (Exencion de inmunizaciones por razones de conciencia)
Immunization - 293
Forms
F21-13510A
Solicitud para la Certificacion del Promotor(a) de Salud (Application)
Community Hlth Wrkr 370
Forms
F21-13511A
Solicitud para la Certificacion del Instructor(a) (Application)
Community Hlth Wrkr 370
Forms
ETB-415A
Formulario de consentimiento tratamiento para la infeccion de tuberculosis latente
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-411A
Formulario de declaraciones y aceptacion tratamiento de la tuberculosis
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-409A
Reconocimiento de Entendimiento Disposicion de Drogas Antituberculosas Limitadas para Clientes-TB
Infectious Disease Control Unit - TB - 320
Electronic File
EKHC-3A
Formulario para cobros de transportacion (Kidney Health Care Transportation Claim Form)
Kidney Health Care - 180
Electronic File
ETB-410A
Orden para Implementar y Llevar a Cabo Medidas Para un Paciente con Tuberculosis
Infectious Disease Control Unit - TB - 320
Electronic File
EJ-6A
Disclosure and Consent for HIV
HIV/STD - 734
Electronic File
E25TAC601.4(a)(2
Divulgacion de informacion y consentimiento procedimientos medicos y quirurgicos
Health Facility Licensing 635
Electronic File
EF12-11494A
Cuestionario de Tuberculosis [TB Questionnaire (Spanish)]
Infectious Disease Control Unit - TB - 320
Electronic File
C-92A
Vacuna Sarampion, las Paperas, y la Rubeola-lo que usted necesita saber (Limit 200)
Immunization - 710
Forms
ECD-011-Span
Raspadura de la Piel para Casos o Sospechosos de la Enfermedad de Hansen’s
Infectious Disease - 629
Electronic File
ECD-010A
Biopsia de la Piel para Casos o Sospechosos de la Enfermedad de Hansen
Infectious Disease - 629
Electronic File
E25TAC601.5(2)
Divulgacion de informacion y consentimiento para radioterapia
Health Facility Licensing 635
Electronic File
E25TAC601.8(2)
Divulgacion de informacion y consentimiento para histerectomia
Health Facility Licensing 635
Electronic File
EF11-13285A
Cuestionario de evaluacion de la Vacuna inyectable del 2009 contra la Influenza H1N1
Immunization - 832
Electronic File
EF11-13286A
Cuestionario de evaluacion de la Vacuna intranasal del 2009 contra la Influenza H1N1
Immunization - 832
Electronic File
EF105-12318A
Hoja de sintomas y efectos secundarios-La mania (Symptoms/side effects: Bipolar Disorder)
TIMA-Patient/Family Ed 586
Electronic File
C-85A
Vacuna Neumococica conjugada-Lo que usted necesita saber (Pneumococcal Conjugate Vaccine)
Immunization - 710
Forms
C-86A
Vacuna Neumococica Polisacarida-lo que usted necesita saber (Pneumococcal Disease/Vaccine)
Immunization - 710
Forms
EF21-11809A
Forma para la Determinacion de Elegibilidad (Eligibility Determination) (Title V)
Title V - 461
Electronic File
C-114A
Vacuna contra El PV (Virus del Papiloma Humano) (Gardasil)-Lo Que debe Saber (VIS)
Immunization - 293
Forms
C-90A
Vacuna Antipoliomielitica-Lo que usted necesita saber (Inactivated Polio-IPV)
Immunization - 710
Forms
C-95A
Vacuna Contra La Hepatitis A-lo que usted necesita saber (Hepatitis A Vaccine)
Immunization - 710
Forms
C-106A
Vacuna Contra La Hepatitis B-lo que usted necesita saber (Hepatitis B Vaccine) (Limit 200)
Immunization - 710
Forms
EF14-13230A
Uso y almacenamiento de tarjetas de recogida de gotas de sangre para pruebas de deteccion temprana a
Labs - 819
Electronic File
C-91A
Vacunas Difteria, Tetanos, y Tos Ferina-lo que usted necesita saber (Tetanus, Diphtheria and Pertus)
Immunization - 710
Forms
Stock #4-25-lang Revised 10/25/2010
Page 202 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EF105-12317A
Hoja de sintomas y efectos secundarios-La depresion (Symptoms/side effects: Depression)
TIMA-Patient/Family Ed 586
Electronic File
EF105-12316A
Hoja de sintomas y efectos secundarios-La Esquizofrenia (Symptoms/side effects: Schizophrenia)
TIMA-Patient/Family Ed 586
Electronic File
EF21-11817A
Elegibilidad Condicional (Presumptive Eligilibility) (Title V)
Title V - 461
Electronic File
C-94A
Vacuna contra Tetanos y Difteria-lo que usted necesita saber (Tetanus and Diphtheria)
Immunization - 710
Forms
CD-001A
Medicamento Como Terapia Para el Tratamiento de la Enfermedad de Hansen
Hansen's Disease - 83
Forms
C-108A
Haemophilus influenzae Tipo b (Hib)-Lo que usted necesita saber (Haemophilus Influenza Type B)
Immunization - 710
Forms
EC-94A
Vacuna contra Tetanos y Difteria-lo que usted necesita saber (Tetanus and Diphtheria) (VIS)
Immunization - 781
Electronic File
EF07-12808A
Formulario de inscripcion en el registro de Texas Glenda Dawson Done Vida
Donate Life Texas Registry - 719
Electronic File
EF21-13513A
Solicitud de Renovacion del Certificado del Instructor(a)
Community Hlth Wrkr 371
Electronic File
EF21-13511A
Solicitud para la Certificacion del Instructor(a) (Application)
Community Hlth Wrkr 371
Electronic File
EF23-13281A
Formulario: 1-A Entrevista de empleados condicionales y empleados alimentarios
Food Establishments - 811
Electronic File
EF01-11421A
Department of State Health Services Standard Out-of-Hospital Do Not Resuscitate Order (DNR)
EMS - 722
Electronic File
EC-97A
Vacuna contra la varicela-lo que usted necesita saber (Chickenpox Vaccine) (VIS)
Immunization - 781
Electronic File
EC-99A
Vacuna Contra La Rabia-lo que usted necesita saber (Rabies-What You Need to Know) (VIS)
Immunization - 781
Electronic File
EF21-13510A
Solicitud para la Certificacion del Promotor(a) de Salud (Application)
Community Hlth Wrkr 371
Electronic File
EC-95A
Vacuna Contra La Hepatitis A-lo que usted necesita saber (Hepatitis A Vaccine)(VIS)
Immunization - 781
Electronic File
EC-96A
Vacuna Meningococica-lo que usted necesita saber (Meningococcal Vaccine-What You Need to Know) (VIS)
Immunization - 781
Electronic File
ECORE-4B
Historia de dieta (Diet History) (no print copy available)
Public Health Nursing - 263 Electronic File
CPW-12S
Autorizacion para divulgar la informacion confidencial (Case Management)
Case Management - 309
Electronic File
EF41-11811A
Solicitud Para Asistencia (Hemophilia Assistance-Application for Assistance-Adults over 21)
Hemophilia Assistance 404
Electronic File
EC-106A
Vacuna Contra La Hepatitis B-lo que usted necesita saber (Hepatitis B Vaccine) (VIS)
Immunization - 781
Electronic File
EF21-13512A
Solicitud de Renovacion del Certificado del Promotor(a) de Salud
Community Hlth Wrkr 371
Electronic File
EC-85A
Vacuna Neumococica conjugada-Lo que usted necesita saber (Pneumococcal Conjugate Vaccine) (VIS)
Immunization - 781
Electronic File
EC-108A
Haemophilus influenzae Tipo b (Hib)-Lo que usted necesita saber (Haemophilus Influenza Type B) (VIS)
Immunization - 781
Electronic File
EC-109A
Vacunas Difteria, Tetanos y los Ferina - Lo Que Usted Necesita Saber (Tetanus, Diptheria, Pertussis
Immunization - 781
Electronic File
EC-114A
Vacuna contra El PV (Virus del Papiloma Humano) (Gardasil)-Lo Que debe Saber (VIS)
Immunization - 41
Electronic File
EF32-11043A
Declaracion de Consentimiento y Liberacion de Responsabilidad (Model Release Form)
Web Technology Services - 392
Electronic File
EC-93A
Vacuna Desactivada Contra la Gripe-Lo que usted necesita saber (Inactivated Influenza Vaccine) (VIS)
Immunization - 781
Electronic File
EC-86A
Vacuna Neumococica Polisacarida-lo que usted necesita saber (Pneumococcal Disease/Vaccine) (VIS)
Immunization - 781
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 203 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EC-87A
Vacuna Intranasal Viva Contra la Gripe-Lo que usted necesita saber (Live Intranasal Influenza) (VIS)
Immunization - 781
Electronic File
EC-89A
Vacuna Antipoliomielitica Oral-lo que usted necesita saber (Oral Polio Vaccine) (VIS)
Immunization - 41
Electronic File
EC-90A
Vacuna Antipoliomielitica-Lo que usted necesita saber (Inactivated Polio-IPV) (VIS)
Immunization - 781
Electronic File
EF09-11927A
Exposicion a los pesticidas por los humanos
Pesticide Exposure Surv (PEST) - 452
Electronic File
EC-91A
Vacunas Difteria, Tetanos, y Tos Ferina-lo que usted necesita saber (VIS)
Immunization - 781
Electronic File
EC-92A
Vacuna Sarampion, las Paperas, y la Rubeola-lo que usted necesita saber (VIS)
Immunization - 781
Electronic File
ECD-001A
Medicamento Como Terapia Para el Tratamiento de la Enfermedad de Hansen
Infectious Disease - 629
Electronic File
Forms-Eligibility / Formularios--elegibilidad EF21-11809A
Forma para la Determinacion de Elegibilidad (Eligibility Determination) (Title V)
Title V - 461
Electronic File
EWIC-35-1A
Forma de informacion adicional Oportunidad de registrarse para votar-Forma NVRA-WIC
Nutrition Services - 401
Electronic File
F41-11811A
Solicitud Para Asistencia (Hemophilia Assistance-Application for Assistance-Adults over 21)
Hemophilia Assistance 403
Forms
EF21-11845A
Aviso de elegibilidad (Notice of Eligibliity) (Title V/PHC Contract Programs)
Title V - 461
Electronic File
WIC-35-3A
Proof of Income (WIC)
Nutrition Services - 885
Forms
EF21-11817A
Elegibilidad Condicional (Presumptive Eligilibility) (Title V)
Title V - 461
Electronic File
EF41-11811A
Solicitud Para Asistencia (Hemophilia Assistance-Application for Assistance-Adults over 21)
Hemophilia Assistance 404
Electronic File
EWIC-35-3A
Cuestionario del programa WIC sobre los ingresos (WIC Income Questionnaire)
Nutrition Services - 401
Electronic File
EF21-11844A
Evaluacion de elegibilidad para asistencia de servicios medicos (Screening Document for Medical Serv
Title V - 461
Electronic File
Forms-Licensing / Formularios--autorizacion F66-10717A
Midwife Informed Choice and Disclosure Statement
Midwifery Program - 124
Forms
F66-10715A
Midwife - Newborn Screening Test Objection Form
Midwifery Program - 124
Forms
Forms-Reporting / Formularios--reportajes EF09-11927A
Exposicion a los pesticidas por los humanos
Pesticide Exposure Surv (PEST) - 452
Electronic File
EF12-11494A
Cuestionario de Tuberculosis [TB Questionnaire (Spanish)]
Infectious Disease Control Unit - TB - 320
Electronic File
Forms-Vital Statistics / Formularios de Estadisticas Vital EFVS-109A.1
Hoja de trabajo de la madre sobre el acta de nacimiento de su criatura (Mother's worksheet)
Vital Statistics - 758
Electronic File
FVS-109A.1
Hoja de trabajo de la madre sobre el acta de nacimiento de su criatura (Mother's worksheet)
Vital Statistics - 71
Forms
Genetics / Genetica E05-10282A
Metodos de Herencia (Methods of Inheritance)
Genetics Services - 69
Electronic File
E05-10549A
Manual De Galactosemia: Guia para las Familias (Galactosemia Handbook)
Newborn Screening - 318
Electronic File
E06-10472A
Newborn Screening Card
Newborn Screening - 319
Electronic File
E05-10370A
Algunos Puntos Importantes que Recordar sobre Los Examenes Prenatales
Genetics Services - 69
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 204 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
E05-10333A
DOLOR en el Nino con Enfermedad de Celula Falciforme (Pain in the Child with Sickle Cell Disease)
Newborn Screening - 313
Electronic File
E05-10332A
Anemia De Celula Falciforme y Ataques (Sickle Cell Anemia and Stroke)
Newborn Screening - 313
Electronic File
E05-10331A
Talasemia Falciforme Beta Cero (Sickle Beta Zero Thalassemia)
Newborn Screening - 313
Electronic File
E05-10328A
Crisis Aplastica (Aplastic Crisis)
Newborn Screening - 313
Electronic File
E05-10327A
Priapismo (Priapism)
Newborn Screening - 313
Electronic File
E05-10588A
Prueba Selectiva Sencilla (Simple Spot Check)
Newborn Screening - 556
Posters
E05-10283A
Anormalidades Menores (Minor Anomalies)
Genetics Services - 69
Electronic File
E05-10586A
Preguntas que Probablemente Desee Hacer a su Especialista en Genetica
Genetics Services - 69
Electronic File
E05-10093A
Cuando Necesita un Nino/Adulto los Servicios Geneticos?
Genetics Services - 69
Electronic File
E05-10004A
El CAHOOT (The CAHOOT Newsletter)
Newborn Screening - 282
Electronic Newsletter/Magazine
E05-03945A
Anemia de celulas falciformes: Una guia para padres de ninos en edad escolar
Newborn Screening - 313
Electronic File
E05-03880A
Crisis Aplastica (Aplastic Crisis)
Newborn Screening - 313
Electronic File
E05-03876A
Infeccion Neumococica y Penicilina (Pneumococcal Infection and Penicillin)
Newborn Screening - 313
Electronic File
E05-03872A
Talasemia Falciforme Beta+ (Sickle Beta+ Thalassemia)
Newborn Screening - 313
Electronic File
05-10589A
Procedimiento de toma y manipulacion de muestras de sangre para pruebas en recien nacidos (max 5)
Newborn Screening - 67
Posters
05-10588A
Prueba Selectiva Sencilla (Simple Spot Check)(Limit 5)
Newborn Screening - 67
Posters
05-10004A
El CAHOOT (The CAHOOT Newsletter) (Limit 5)
Newborn Screening - 67
Newsletters
E05-10326A
Sindrome de Pecho (Chest Syndrome)
Newborn Screening - 313
Electronic File
E05-10822A
Tarjeta Del Alimento De Galactosemia (Galactosemia Food Card)
Newborn Screening - 318
Electronic File
E05-11339A
Examen de Deteccion Triple (Triple Screen)
Genetics Services - 69
Electronic File
E05-11537A
El ABC de la hiperplasia adrenal congenita (The ABCs of Congenital Adrenal Hyperplasia)
Newborn Screening - 282
Electronic File
E1-196A
Hipotiroidismo Secundario Guia de diagnostico y tratamiento (Secondary Hypothyroidism Diagnosis)
Newborn Screening - 317
Electronic File
E1-206A
Hiperplasia Adrenal Congenita: Libro de Informacion para los Padres (Congenital Adrenal Hyperplasia)
Newborn Screening - 282
Electronic File
E1-319A
Informacion que los padres desean recibir del examen medico del recien nacido (What Parents Want to
Newborn Screening - 68
Electronic File
E1-63A
Screening para los recien nacidos: Para la salud de su bebe (Newborn Screening)
Newborn Screening - 68
Electronic File
E1-66A
Con Que Su Bebe Tiene El Rasgo de Globulos Falciformes (So Your Baby Has the Sickle Cell Trait)
Newborn Screening - 313
Electronic File
NBS-magnet-Sp
Step by Step: Your New Baby Must Have a Second Screening Test at 1-2 Weeks of Age (Limit 5)
Newborn Screening - 136
Magnets
E05-10589A
Procedimiento de toma y manipulacion de muestras de sangre para pruebas en recien nacidos
Newborn Screening - 556
Posters
E05-10383A
Amniocentesis: Un Diagnostico Prenatal (Amniocentesis: For Prenatal Diagnosis)
Genetics Services - 69
Electronic File
Hansen's Disease / Enfermedad de Hansen ECD-010A
Biopsia de la Piel para Casos o Sospechosos de la Enfermedad de Hansen
Infectious Disease - 629
Electronic File
ECD-001A
Medicamento Como Terapia Para el Tratamiento de la Enfermedad de Hansen
Infectious Disease - 629
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 205 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
ECD-011-Span
Raspadura de la Piel para Casos o Sospechosos de la Enfermedad de Hansen’s
Infectious Disease - 629
Electronic File
CD-001A
Medicamento Como Terapia Para el Tratamiento de la Enfermedad de Hansen
Hansen's Disease - 83
Forms
Hemophilia / Hemofilia EF41-11811A
Solicitud Para Asistencia (Hemophilia Assistance-Application for Assistance-Adults over 21)
Hemophilia Assistance 404
Electronic File
F41-11811A
Solicitud Para Asistencia (Hemophilia Assistance-Application for Assistance-Adults over 21)
Hemophilia Assistance 403
Forms
Hepatitis / Hepatitis C-95A
Vacuna Contra La Hepatitis A-lo que usted necesita saber (Hepatitis A Vaccine)
Immunization - 710
Forms
EC-95A
Vacuna Contra La Hepatitis A-lo que usted necesita saber (Hepatitis A Vaccine)(VIS)
Immunization - 781
Electronic File
EC-106A
Vacuna Contra La Hepatitis B-lo que usted necesita saber (Hepatitis B Vaccine) (VIS)
Immunization - 781
Electronic File
E59-11529A
Hepatitis es una enfermedad del higado (Hep C At-Risk Adult)
Infectious Disease - 533
Electronic File
E13-11908A
El riesgo de comer ostiones crudos (Risk of Eating Raw Oysters)
HIV/STD - 449
Fact Sheets
C-106A
Vacuna Contra La Hepatitis B-lo que usted necesita saber (Hepatitis B Vaccine) (Limit 200)
Immunization - 710
Forms
E59-11527A
Hepatitis es una enfermedad del higado (Hep C At-Risk Youth)
Infectious Disease - 533
Electronic File
Hygiene / Higiene E5-200A
Cubra su tos (Cover Your Cough)
Infectious Disease - 602
Electronic File
E23-12785A
Los Empleados se deben lavar las manos antes de volver al trabajo (handwash poster)
Food Establishments - 713
Electronic File
E23-12787A
Doble Lava Manos (Double Handwash poster)
Food Establishments - 713
Electronic File
E25-12785A
Empleado obligado a lavarse las manos (Employees Must Wash Hands Before Returning to Work)
Food Establishments - 713
Electronic File
E5-100A
Conciencia soble la higiene contra el SARM (MRSA Hygiene Awareness)
Infectious Disease - 400
Electronic File
Immunization / Inmunizacion F11-11755A
Declaracion jurada (Exencion de inmunizaciones por razones de conciencia)
Immunization - 293
Forms
EF11-13286A
Cuestionario de evaluacion de la Vacuna intranasal del 2009 contra la Influenza H1N1
Immunization - 832
Electronic File
EF11-13285A
Cuestionario de evaluacion de la Vacuna inyectable del 2009 contra la Influenza H1N1
Immunization - 832
Electronic File
E11-12051A
Vacuna Contra Fiebre Amarilla-Lo que usted necesita saber (Yellow Fever Vaccine-VIS)
Immunization - 41
Electronic File
EC-111A
Vacuna Contra el VPH (Virus del Papiloma Humano) Lo que debe saber (Cervarix) (VIS)
Immunization - 781
Electronic File
EC-110A
Vacuna Contra El Rotavirus: Lo Que Usted Necesita Saber (VIS)
Immunization - 781
Electronic File
EC-108A
Haemophilus influenzae Tipo b (Hib)-Lo que usted necesita saber (Haemophilus Influenza Type B) (VIS)
Immunization - 781
Electronic File
C-112A
Vacuna Contra la Culebrilla - Lo Que Usted Necesita Saber (Shingles Vaccine) (VIS)
Immunization - 710
Forms
EC-106A
Vacuna Contra La Hepatitis B-lo que usted necesita saber (Hepatitis B Vaccine) (VIS)
Immunization - 781
Electronic File
E6-67A
La Historia de las Vacunas (Booklet)
Immunization - 781
Electronic File
Estos son los momentos que usted siempre va a querer recordar
Immunization - 781
Electronic File
E6-205A
Stock #4-25-lang Revised 10/25/2010
Page 206 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
C-111A
Vacuna Contra el VPH (Virus del Papiloma Humano) Lo que debe saber (Cervarix) (VIS) (Limit 200)
Immunization - 710
Forms
E6-105A
Calendario de vacunas recomendadas para ninos y adolescentes en Estados Unidos
Immunization - 781
Electronic File
E6-104A
Calendario de vacunas recomendadas para adultos-Estados Unidos (Recommended Adult Immunization)
Immunization - 781
Electronic File
E1-316A
Informacion para los padres de los recien nacidos (Information for Parents of Newborns-SB 316)
Perinatal/Maternal/Child 539
Electronic File
EC-99A
Vacuna Contra La Rabia-lo que usted necesita saber (Rabies-What You Need to Know) (VIS)
Immunization - 781
Electronic File
E11-12811A
A los ninos pequenos tambien les da la gripe (Little Kids Get theFlu Too)
Immunization - 781
Electronic File
EC-109A
Vacunas Difteria, Tetanos y los Ferina - Lo Que Usted Necesita Saber (Tetanus, Diptheria, Pertussis
Immunization - 781
Electronic File
E11-12050A
Fiebre Tifoidea-Lo que usted necesita saber (Typhoid Vaccine-What You Need to Know)
Immunization - 41
Electronic File
E11-11966A
Vacunelos! Nuestros angelitos merecen proteccion (Play it Safe. Vaccinate)
Immunization - 781
Electronic File
E11-11700A
Cualquier persona puede contraer la pertussis (tos ferina) (Anyone Can Get Pertussis-Adult)
Immunization - 781
Electronic File
E11-11530A
Es solamente una tos? O mas bien es la pertussis (tos ferina)? (Pertussis brochure)
Immunization - 781
Electronic File
E11-11161A
Vacuna contra el carbunco (Antrax)-Lo que usted necesita saber (Anthrax Vaccine-VIS)
Immunization - 41
Electronic File
C-95A
Vacuna Contra La Hepatitis A-lo que usted necesita saber (Hepatitis A Vaccine)
Immunization - 710
Forms
C-94A
Vacuna contra Tetanos y Difteria-lo que usted necesita saber (Tetanus and Diphtheria)
Immunization - 710
Forms
C-92A
Vacuna Sarampion, las Paperas, y la Rubeola-lo que usted necesita saber (Limit 200)
Immunization - 710
Forms
C-91A
Vacunas Difteria, Tetanos, y Tos Ferina-lo que usted necesita saber (Tetanus, Diphtheria and Pertus)
Immunization - 710
Forms
C-90A
Vacuna Antipoliomielitica-Lo que usted necesita saber (Inactivated Polio-IPV)
Immunization - 710
Forms
C-86A
Vacuna Neumococica Polisacarida-lo que usted necesita saber (Pneumococcal Disease/Vaccine)
Immunization - 710
Forms
C-85A
Vacuna Neumococica conjugada-Lo que usted necesita saber (Pneumococcal Conjugate Vaccine)
Immunization - 710
Forms
E11-13314A
2009 E-card (Electronic postcard-Immunizations)
Immunization - 844
Electronic File
EC-91A
Vacunas Difteria, Tetanos, y Tos Ferina-lo que usted necesita saber (VIS)
Immunization - 781
Electronic File
EC-86A
Vacuna Neumococica Polisacarida-lo que usted necesita saber (Pneumococcal Disease/Vaccine) (VIS)
Immunization - 781
Electronic File
C-110A
Vacuna contra el Rotavirus - Lo Que Usted Necesita Saber (Limit 200)
Immunization - 710
Forms
C-108A
Haemophilus influenzae Tipo b (Hib)-Lo que usted necesita saber (Haemophilus Influenza Type B)
Immunization - 710
Forms
EC-89A
Vacuna Antipoliomielitica Oral-lo que usted necesita saber (Oral Polio Vaccine) (VIS)
Immunization - 41
Electronic File
C-106A
Vacuna Contra La Hepatitis B-lo que usted necesita saber (Hepatitis B Vaccine) (Limit 200)
Immunization - 710
Forms
EC-112A
Vacuna Contra la Culebrilla - Lo Que Usted Necesita Saber (Shingles Vaccine) (VIS)
Immunization - 781
Electronic File
EC-90A
Vacuna Antipoliomielitica-Lo que usted necesita saber (Inactivated Polio-IPV) (VIS)
Immunization - 781
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 207 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
EC-85A
Vacuna Neumococica conjugada-Lo que usted necesita saber (Pneumococcal Conjugate Vaccine) (VIS)
Immunization - 781
Electronic File
EC-92A
Vacuna Sarampion, las Paperas, y la Rubeola-lo que usted necesita saber (VIS)
Immunization - 781
Electronic File
EC-93A
Vacuna Desactivada Contra la Gripe-Lo que usted necesita saber (Inactivated Influenza Vaccine) (VIS)
Immunization - 781
Electronic File
EC-94A
Vacuna contra Tetanos y Difteria-lo que usted necesita saber (Tetanus and Diphtheria) (VIS)
Immunization - 781
Electronic File
EC-95A
Vacuna Contra La Hepatitis A-lo que usted necesita saber (Hepatitis A Vaccine)(VIS)
Immunization - 781
Electronic File
EC-96A
Vacuna Meningococica-lo que usted necesita saber (Meningococcal Vaccine-What You Need to Know) (VIS)
Immunization - 781
Electronic File
EC-97A
Vacuna contra la varicela-lo que usted necesita saber (Chickenpox Vaccine) (VIS)
Immunization - 781
Electronic File
11-12815A
Iman: Las vacunas equivalan proteccion completa (Vaccines Full Protection -magnet)
Immunization - 293
Magnets
C-114A
Vacuna contra El PV (Virus del Papiloma Humano) (Gardasil)-Lo Que debe Saber (VIS)
Immunization - 293
Forms
EC-114A
Vacuna contra El PV (Virus del Papiloma Humano) (Gardasil)-Lo Que debe Saber (VIS)
Immunization - 41
Electronic File
EC-83A
H1N1 Lo que usted necesita saber Vacuna intranasal viva contra la influenza (VIS)
Immunization - 41
Electronic File
EC-87A
Vacuna Intranasal Viva Contra la Gripe-Lo que usted necesita saber (Live Intranasal Influenza) (VIS)
Immunization - 781
Electronic File
EC-84A
2009 H1N1 Inactivated Influenza Vaccine - What You Need to Know (VIS)
Immunization - 41
Electronic File
Infants - Care & Hygiene / Bebes--su cuidado e higiene E1-63A
Screening para los recien nacidos: Para la salud de su bebe (Newborn Screening)
Newborn Screening - 68
Electronic File
E13-53A
Solo para el papa (Just for Dad)
Nutrition Services - 809
Electronic File
E1-319A
Informacion que los padres desean recibir del examen medico del recien nacido (What Parents Want to
Newborn Screening - 68
Electronic File
E1-316A
Informacion para los padres de los recien nacidos (Information for Parents of Newborns-SB 316)
Perinatal/Maternal/Child 539
Electronic File
NBS-magnet-Sp
Step by Step: Your New Baby Must Have a Second Screening Test at 1-2 Weeks of Age (Limit 5)
Newborn Screening - 136
Magnets
E05-05015A
Hipotiroidismo Y Su Infante (Hypothyroidism and Your Infant)
Newborn Screening - 317
Electronic File
Newborn Screening Card
Newborn Screening - 319
Electronic File
E06-10472A
Infants - Nutrition / Bebes--su nutricion E13-46A
Leche materna para bebes prematuros (Mother's Milk For Premature Babies)
Nutrition Services - 570
Electronic File
E1-63A
Screening para los recien nacidos: Para la salud de su bebe (Newborn Screening)
Newborn Screening - 68
Electronic File
Informacion Sobre La Peste (Facts About Plague)
Zoonosis - 376
Electronic File
Encefalitis (Encephalitis)
Zoonosis - 376
Electronic File
Insect Control / Control de insectos E7-36A E7-7A
Kidney Health / Salud del rinon EKHC-010A
Acaba de solicitar KHC! (You Just Applied to KHC!)
Kidney Health Care - 180
Electronic File
EKHC-3A
Formulario para cobros de transportacion (Kidney Health Care Transportation Claim Form)
Kidney Health Care - 180
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 208 of 221
Stock Number KHC-3A
Title
Format
Source (must print Contact List to have all necessary information)
Formulario para cobros de transportacion (Kidney Health Care Transportation Claim Form)
Kidney Health Care - 179
Forms
Laboratories & Laboratory Safety / Laboratorios y Seguridad de laboratorios G-2B-Span
Formulario de remision de muestras-bacteriologia y parasitologia
Labs - 388
Forms
E14-13308A
Inmunodeficiencia combinada grave (SCID)
Labs - 819
Electronic File
E05-10589A
Procedimiento de toma y manipulacion de muestras de sangre para pruebas en recien nacidos
Newborn Screening - 556
Posters
E05-10588A
Prueba Selectiva Sencilla (Simple Spot Check)
Newborn Screening - 556
Posters
G-1C-Span
Exam sistematico triple prenatal del suero materno
Labs - 388
Forms
G-1B-Span
Formulario de remision de muestras-Quimica clinica y Estudios del AND
Labs - 388
Forms
05-10589A
Procedimiento de toma y manipulacion de muestras de sangre para pruebas en recien nacidos (max 5)
Newborn Screening - 67
Posters
EF14-13230A
Uso y almacenamiento de tarjetas de recogida de gotas de sangre para pruebas de deteccion temprana a
Labs - 819
Electronic File
G-2A-Span
Formulario de remision de muestras-Serologia y virologia
Labs - 388
Forms
05-10588A
Prueba Selectiva Sencilla (Simple Spot Check)(Limit 5)
Newborn Screening - 67
Posters
Childhood Lead Poisoning - 386
Electronic File
Lead Poisoning / Intoxicacion por plomo E1-26A
Proteja a sus ninos contra el envenenamiento de plomo (What Parents Need to Know About Lead Poison)
Licensing & Regulation / Autorizacion y Reglamentacion Midwife - Newborn Screening Test Objection Form
Midwifery Program - 124
Forms
TAC139.6(a)(2)
Linea de informacion gratuita (centro de aborto)
Abortion Facility Licensing - 634
Electronic File
F66-10717A
Midwife Informed Choice and Disclosure Statement
Midwifery Program - 124
Forms
E77-11356A
Guia para el consumidor: licencia para el trabajador social (Consumer's Guide to Social Work Licens)
Tx State Bd of Social Worker Examiners - 358
Electronic File
Epidemiology/Injury Surveillance - 351
Electronic File
F66-10715A
Lifestyles & Health / Estilos de vida y Salud E07-11640A
Los importantes primeros pasos para apoyar a un ser querido que padece una lesion cerebral
Medicare/Medicaid / Medicare/Medicaid MTP-210S
Medicaid-Transporte gratis (tarjeta para la cartera)
Texas Health Steps - 24
Small card
EMTP-610S
Medicaid-Transporte gratis (calcomania)
Texas Health Steps - 24
Stickers
Medicine / Medicina E105-12319A
La depresion (Medication Benefit Sheet: Depression)
TIMA-Patient/Family Ed 586
Electronic File
E105-12320A
La mania (Medication Benefit Sheet: Mania)
TIMA-Patient/Family Ed 586
Electronic File
E59-11511A
Guia para los padres-Use los antibioticos en forma inteligente (GuideGet Smart about Antibiotics)
Infectious Disease - 638
Electronic File
E05-10586A
Preguntas que Probablemente Desee Hacer a su Especialista en Genetica
Genetics Services - 69
Electronic File
E05-10328A
Crisis Aplastica (Aplastic Crisis)
Newborn Screening - 313
Electronic File
E05-10333A
DOLOR en el Nino con Enfermedad de Celula Falciforme (Pain in the Child with Sickle Cell Disease)
Newborn Screening - 313
Electronic File
E1-206A
Hiperplasia Adrenal Congenita: Libro de Informacion para los Padres (Congenital Adrenal Hyperplasia)
Newborn Screening - 282
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 209 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E05-10332A
Anemia De Celula Falciforme y Ataques (Sickle Cell Anemia and Stroke)
Newborn Screening - 313
Electronic File
E05-10331A
Talasemia Falciforme Beta Cero (Sickle Beta Zero Thalassemia)
Newborn Screening - 313
Electronic File
E25TAC601.4(a)(2
Divulgacion de informacion y consentimiento procedimientos medicos y quirurgicos
Health Facility Licensing 635
Electronic File
E105-12321A
Ansiedad (Medication Benefit Sheet: Anxiety)
TIMA-Patient/Family Ed 586
Electronic File
E25TAC601.8(2)
Divulgacion de informacion y consentimiento para histerectomia
Health Facility Licensing 635
Electronic File
E105-12322A
Psicosis (Medication Benefit Sheet: Psychosis)
TIMA-Patient/Family Ed 586
Electronic File
E59-12228A
Que Hacer y No Que Hacer en el uso de antibioticos (Antibiotic Use Do's and Don'ts)
Infectious Disease - 638
Electronic File
E59-12229A
Lo Que Usted Debe Saber Acerca del uso del antibioticos(What You Should Know about using Antibiotics
Infectious Disease - 638
Electronic File
EF01-11421A
Department of State Health Services Standard Out-of-Hospital Do Not Resuscitate Order (DNR)
EMS - 722
Electronic File
EF105-12316A
Hoja de sintomas y efectos secundarios-La Esquizofrenia (Symptoms/side effects: Schizophrenia)
TIMA-Patient/Family Ed 586
Electronic File
EF105-12317A
Hoja de sintomas y efectos secundarios-La depresion (Symptoms/side effects: Depression)
TIMA-Patient/Family Ed 586
Electronic File
EF105-12318A
Hoja de sintomas y efectos secundarios-La mania (Symptoms/side effects: Bipolar Disorder)
TIMA-Patient/Family Ed 586
Electronic File
EPSDT-12S
Chequeos-Pasos Sanos de Tejas (Checkups Poster -Texas Health Steps)
Texas Health Steps - 24
Electronic File
EPSDT-13S
Citas con su medico y dentista (Appointments Education Poster) (16" x 20")
Texas Health Steps - 24
Electronic File
EPSDT-15S
La administracion de casos para los ninos y las mujeres embarazadas (Poster) 8-1/2" x 11"
Texas Health Steps - 24
Electronic File
F105-12316A
Hoja de sintomas y efectos secundarios-La Esquizofrenia (Symptoms/side effects: Schizophrenia)
TIMA-Patient/Family Ed 585
Forms
F105-12317A
Hoja de sintomas y efectos secundarios-La depresion (Symptoms/side effects: Depression)
TIMA-Patient/Family Ed 585
Forms
F105-12318A
Hoja de sintomas y efectos secundarios-La mania (Symptoms/side effects: Bipolar Disorder)
TIMA-Patient/Family Ed 585
Forms
E25TAC601.5(2)
Divulgacion de informacion y consentimiento para radioterapia
Health Facility Licensing 635
Electronic File
E05-10326A
Sindrome de Pecho (Chest Syndrome)
Newborn Screening - 313
Electronic File
E05-05015A
Hipotiroidismo Y Su Infante (Hypothyroidism and Your Infant)
Newborn Screening - 317
Electronic File
E05-03945A
Anemia de celulas falciformes: Una guia para padres de ninos en edad escolar
Newborn Screening - 313
Electronic File
E05-03880A
Crisis Aplastica (Aplastic Crisis)
Newborn Screening - 313
Electronic File
E05-03872A
Talasemia Falciforme Beta+ (Sickle Beta+ Thalassemia)
Newborn Screening - 313
Electronic File
E05-10327A
Priapismo (Priapism)
Newborn Screening - 313
Electronic File
Men - Health & Hygiene / Hombres--salud e higiene E10-53A
Vivir con su propla decision (Living With Your Own Decision: Facts about Prostate Cancer Screening)
Adult Health - 231
Electronic File
E05-10327A
Priapismo (Priapism)
Newborn Screening - 313
Electronic File
Warehouse
Fact Sheets
Mental Health / Salud mental B-101A
El Disturbio Bipolar (Brain Function Sheet: Bipolar Disorder) (Limit 1)
Stock #4-25-lang Revised 10/25/2010
Page 210 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E105-12321A
Ansiedad (Medication Benefit Sheet: Anxiety)
TIMA-Patient/Family Ed 586
Electronic File
E105-12326A
Tecnicas sugeridas para tratar sintomas persistentes (Suggested techniques-coping-persistent symptom
TIMA-Patient/Family Ed 586
Electronic File
E105-12320A
La mania (Medication Benefit Sheet: Mania)
TIMA-Patient/Family Ed 586
Electronic File
E105-12331A
Diagosis y Tratamiento (Consumer to Consumer-Peer Facilitator Guide)
TIMA-Patient/Family Ed 586
Electronic File
E105-12319A
La depresion (Medication Benefit Sheet: Depression)
TIMA-Patient/Family Ed 586
Electronic File
B-103A
Kris, Estas Triste? (Kris, Are You Sad?) (Limit 1)
Warehouse
Coloring Books
EB-102A
La depresion (Brain Function Sheet: Depression)
TIMA-Patient/Family Ed 586
Electronic File
E105-12322A
Psicosis (Medication Benefit Sheet: Psychosis)
TIMA-Patient/Family Ed 586
Electronic File
E16-9A
Manual de Derdros del Cliente (Handbook of Consumer Rights Mental Health)
Mental Hlth-Substance Abuse - 670
Electronic File
B-100A
La Esquizofrenia (Brain Function Sheet: Schizophrenia) (Limit 1)
Warehouse
Fact Sheets
EB-100A
La Esquizofrenia (Brain Function Sheet: Schizophrenia)
TIMA-Patient/Family Ed 586
Electronic File
EB-101A
El Disturbio Bipolar (Brain Function Sheet: Bipolar Disorder)
TIMA-Patient/Family Ed 586
Electronic File
B-102A
La depresion (Brain Function Sheet: Depression) (Limit 1)
Warehouse
Fact Sheets
F105-12317A
Hoja de sintomas y efectos secundarios-La depresion (Symptoms/side effects: Depression)
TIMA-Patient/Family Ed 585
Forms
EMH-10A
Los derechos de los adolescentes (Teen's Bill of Rights mental health)
Mental Hlth-Substance Abuse - 670
Electronic File
EB-105A
La mayoria de los ninos(as) que estan deprimidos no le diran sise sienten triste (Most children)
CMAP-Patient/Family Ed 654
Electronic File
F105-12316A
Hoja de sintomas y efectos secundarios-La Esquizofrenia (Symptoms/side effects: Schizophrenia)
TIMA-Patient/Family Ed 585
Forms
F105-12318A
Hoja de sintomas y efectos secundarios-La mania (Symptoms/side effects: Bipolar Disorder)
TIMA-Patient/Family Ed 585
Forms
EF105-12318A
Hoja de sintomas y efectos secundarios-La mania (Symptoms/side effects: Bipolar Disorder)
TIMA-Patient/Family Ed 586
Electronic File
EMH-11A
Declaracion de derechos civiles para todo paciente (Patient's Bill of Rights -mental health)
Mental Hlth-Substance Abuse - 670
Electronic File
EB-103A
Kris, Estas Triste? (Kris, Are You Sad?) (coloring book)
CMAP-Patient/Family Ed 654
Electronic File
MH-2A
El Cuidado de la Salud Mental (Taking Care of Your Mental Health)
Mental Health - 499
Electronic File
EF105-12317A
Hoja de sintomas y efectos secundarios-La depresion (Symptoms/side effects: Depression)
TIMA-Patient/Family Ed 586
Electronic File
MH-8A
Este aviso describe como se puede usar y divulgar la informacion medica sobre usted
Prog Coord, Policy, Innov - 364
Electronic File
MH-5A
La recuperacion emocional en el periodo subsiguiente a un desastre
Mental Health - 499
Electronic File
EF105-12316A
Hoja de sintomas y efectos secundarios-La Esquizofrenia (Symptoms/side effects: Schizophrenia)
TIMA-Patient/Family Ed 586
Electronic File
EB-106A
Tiene me Nino(a) un Trastorno de Atencion? (Does My Child Have an Attention Disorder?)
CMAP-Patient/Family Ed 655
Electronic File
EB-104A
La vida puede ser dificil (Life Can Be Tough)
CMAP-Patient/Family Ed 654
Electronic File
Newborn Screening - 313
Electronic File
Minority Health / Salud de minorias E05-03945A
Anemia de celulas falciformes: Una guia para padres de ninos en edad escolar
Stock #4-25-lang Revised 10/25/2010
Page 211 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E79-10929A
Estudio Sobre Salud y Condicion del Medio Ambiente de los Municipios/Colonias de la Frontera/Texas
Office of Border Health 583
Electronic File
E05-10332A
Anemia De Celula Falciforme y Ataques (Sickle Cell Anemia and Stroke)
Newborn Screening - 313
Electronic File
E05-10326A
Sindrome de Pecho (Chest Syndrome)
Newborn Screening - 313
Electronic File
E05-10327A
Priapismo (Priapism)
Newborn Screening - 313
Electronic File
E05-10328A
Crisis Aplastica (Aplastic Crisis)
Newborn Screening - 313
Electronic File
E05-03876A
Infeccion Neumococica y Penicilina (Pneumococcal Infection and Penicillin)
Newborn Screening - 313
Electronic File
E05-10331A
Talasemia Falciforme Beta Cero (Sickle Beta Zero Thalassemia)
Newborn Screening - 313
Electronic File
E05-05015A
Hipotiroidismo Y Su Infante (Hypothyroidism and Your Infant)
Newborn Screening - 317
Electronic File
E05-10333A
DOLOR en el Nino con Enfermedad de Celula Falciforme (Pain in the Child with Sickle Cell Disease)
Newborn Screening - 313
Electronic File
E10-70A
Paso a Paso-En apoyo de la salud de la mujer hispana a cada paso de su vida
Osteoporosis - 225
Electronic File
E10-72A
El Secreto de la nueva vida de Maria (The Secret of Maria's New Life)
Osteoporosis - 225
Electronic File
E1-66A
Con Que Su Bebe Tiene El Rasgo de Globulos Falciformes (So Your Baby Has the Sickle Cell Trait)
Newborn Screening - 313
Electronic File
E05-03880A
Crisis Aplastica (Aplastic Crisis)
Newborn Screening - 313
Electronic File
E05-03872A
Talasemia Falciforme Beta+ (Sickle Beta+ Thalassemia)
Newborn Screening - 313
Electronic File
El CAHOOT (The CAHOOT Newsletter) (Limit 5)
Newborn Screening - 67
Newsletters
El CAHOOT (The CAHOOT Newsletter)
Newborn Screening - 282
Electronic Newsletter/Magazine
Texas Health Steps - 24
Electronic File
Warehouse
Posters
Newsletters (DSHS) / Boletines informativos (DSHS) 05-10004A E05-10004A
Nursing / Enfermeria EPSDT-15S
La administracion de casos para los ninos y las mujeres embarazadas (Poster) 8-1/2" x 11"
Nutrition / Nutricion 4-191A
Before You Start Making Babies, Start Taking Multivitamins with Folic Acid
Occupational Health & Safety / Salud y seguridad ocupacional 18-10638A
Aviso a los trabajadores (sobre Comunicaciones de Peligro (Notice/Employees-Hazard Communication)
Policy, Standards, & Quality Assurance Unit 100
Posters
E18-10638A
Aviso a los trabajadores (sobre Comunicaciones de Peligro (Notice/Employees-Hazard Communication)
Envir Hlth-PSQA - 55
Electronic File
Organ Donation / Donante de un organo (transplante de organo) EF07-12808A
Formulario de inscripcion en el registro de Texas Glenda Dawson Done Vida
Donate Life Texas Registry - 719
Electronic File
F07-12808A
Formulario de inscripcion en el registro de Texas Glenda Dawson Done Vida
Donate Life Texas Registry - 718
Forms
Osteoporosis / Osteoporosis E10-72A
El Secreto de la nueva vida de Maria (The Secret of Maria's New Life)
Osteoporosis - 225
Electronic File
E10-70A
Paso a Paso-En apoyo de la salud de la mujer hispana a cada paso de su vida
Osteoporosis - 225
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 212 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
Parenting / Crianza de los ninos E59-11511A
Guia para los padres-Use los antibioticos en forma inteligente (GuideGet Smart about Antibiotics)
Infectious Disease - 638
Electronic File
E13-53A
Solo para el papa (Just for Dad)
Nutrition Services - 809
Electronic File
E1-316A
Informacion para los padres de los recien nacidos (Information for Parents of Newborns-SB 316)
Perinatal/Maternal/Child 539
Electronic File
Patient/Client Records / Archivos de pacientes/clientes ECORE-4B
Historia de dieta (Diet History) (no print copy available)
Public Health Nursing - 263 Electronic File
EL-29A
Referral Form Instructions (no print copy available)
Public Health Nursing - 263 Electronic File
TB-620
Registro de Tratamiento Preventivo (Preventive Treatment Record)
Infectious Disease Control Unit - TB - 253
Forms
TB-619
Registro de Tratamiento (Treatment Record)
Infectious Disease Control Unit - TB - 253
Forms
Children w/Special Health Care Needs - 512
Electronic File
Pediatric Medical Care / Atencion pediatrica E07-12153A
Que es un hogar medico? (What is a Medical Home?) (Medical Home Brochure)
Poisons & Poisoning / Venenos e Intoxicaciones EF09-11927A
Exposicion a los pesticidas por los humanos
Pesticide Exposure Surv (PEST) - 452
Electronic File
E1-26A
Proteja a sus ninos contra el envenenamiento de plomo (What Parents Need to Know About Lead Poison)
Childhood Lead Poisoning - 386
Electronic File
E09-12821A
Los pesticidas en su camino (Pesticides in Your Path)
Pesticide Exposure Surv (PEST) - 452
Electronic File
E6-302A
Miguelito aprende acerca de las medidas de seguridad contra venenos (order from 1-800-222-1222)
Environ Epidemiology & Toxicology - 764
Electronic File
6-302A
Miguelito aprende acerca de las medidas de seguridad contra venenos (must order: 1-800-222-1222)
Environ Epidemiology & Toxicology - 764
Coloring Books
Pesticide Exposure Surv (PEST) - 452
Electronic File
Pollution / Contaminacion E09-12821A
Los pesticidas en su camino (Pesticides in Your Path)
Prenatal & Postpartum Care / Cuidado prenatal y posparto E6-73A
Information on Umbilical Cord Blood Banking and Donation (HB 709)
Perinatal/Maternal/Child 735
Electronic File
4-191A
Before You Start Making Babies, Start Taking Multivitamins with Folic Acid
Warehouse
Posters
E05-10370A
Algunos Puntos Importantes que Recordar sobre Los Examenes Prenatales
Genetics Services - 69
Electronic File
E05-10383A
Amniocentesis: Un Diagnostico Prenatal (Amniocentesis: For Prenatal Diagnosis)
Genetics Services - 69
Electronic File
F66-10717A
Midwife Informed Choice and Disclosure Statement
Midwifery Program - 124
Forms
F66-10715A
Midwife - Newborn Screening Test Objection Form
Midwifery Program - 124
Forms
E13-101A
La alimentacion con pecho y la planificacion familiar (Breastfeeding and Family Planning)
Nutrition Services - 809
Electronic File
EPSDT-15S
La administracion de casos para los ninos y las mujeres embarazadas (Poster) 8-1/2" x 11"
Texas Health Steps - 24
Electronic File
E1-316A
Informacion para los padres de los recien nacidos (Information for Parents of Newborns-SB 316)
Perinatal/Maternal/Child 539
Electronic File
E4-206A
10 preguntas sobre el embarazo y el VIH (10 Questions About Pregnancy and HIV)
HIV/STD - 332
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 213 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
Privacy (including HIPAA) / Privacidad (incluyendo HIPAA) MH-8A
Este aviso describe como se puede usar y divulgar la informacion medica sobre usted
Prog Coord, Policy, Innov - 364
Electronic File
EISP-01A
Aviso sobre derechos de la vida privada (HIPAA)
Prog Coord, Policy, Innov - 364
Electronic File
Rabies and Animal Control / Rabia y control de animales 7-39A
Murcielagos y rabia postar para escuelas
Warehouse
Posters
EC-99A
Vacuna Contra La Rabia-lo que usted necesita saber (Rabies-What You Need to Know) (VIS)
Immunization - 781
Electronic File
7-26A
Rabies Poster
Warehouse
Posters
Murcielagos y rabia postar para escuelas
Zoonosis - 376
Electronic File
Health Facility Licensing 635
Electronic File
Zoonosis - 376
Electronic File
Food Establishment - 748
Electronic File
HIV/STD - 449
Fact Sheets
E7-39A
Radiology / Radiologia E25TAC601.5(2)
Divulgacion de informacion y consentimiento para radioterapia
Rodent Control / Control de roedores E7-36A
Informacion Sobre La Peste (Facts About Plague)
Sanitation / Sanidad E23-13414A
Fregadero de Tres Compartimientos (Three Compartment Sink)
Sex Education / Educacion sexual E13-11904A
Como hablar sus ninos acerca del sexo (How to Talk to Your Kids about Sex)
Sexually Transmitted Diseases / Enfermedades de transmision sexual E6-70A
Lo que usted debe saber sobre el Herpes Genital (What You Should Know About Genital Herpes)
HIV/STD - 332
Electronic File
E6-47A
Lo que debe saber sobre la gonorrea (What You Should Know About Gonorrhea)
HIV/STD - 332
Electronic File
E6-136A
Lo que usted debe saber sobre la sifilis (What You Should Know About Syphilis)
HIV/STD - 332
Electronic File
E13-11886A
Lo que usted debe saber acerca de la Trichomoniasis-Hoja informativa
HIV/STD - 449
Electronic File
E6-75A
Lo que deberia saber sobre acerca de la clamidia (What You Should Know About Chlamydia)
HIV/STD - 332
Electronic File
E4-190A
Lo que usted debe sobre el VPH (El virus del papiloma humano)
HIV/STD - 332
Electronic File
E6-123A
Lo que debe saber sobre la PID (La enfermedad imflamatoria pelvica)
HIV/STD - 332
Electronic File
E4-214A
Que debo hacer si he estado expuesto(a) a una enfermedad de transmision sexual (ETS)?
HIV/STD - 332
Electronic File
E13-13206A
Hoja de datos del tratamiento para parejas y personas con clamidia (Treatment Fact Sheet)
TB/HIV/STD - 816
Electronic File
E4-213A
Y en cuanto a sus parejas? (What About Your Partners) (Partner Notification)
HIV/STD - 332
Electronic File
E13-13207A
Hoja de datos del tratamiento para parejas y personas con gonorrea (Treatment fact sheet)
TB/HIV/STD - 816
Electronic File
Sickle Cell Anemia / Anemia drepanocitica E05-10331A
Talasemia Falciforme Beta Cero (Sickle Beta Zero Thalassemia)
Newborn Screening - 313
Electronic File
E05-10326A
Sindrome de Pecho (Chest Syndrome)
Newborn Screening - 313
Electronic File
E1-66A
Con Que Su Bebe Tiene El Rasgo de Globulos Falciformes (So Your Baby Has the Sickle Cell Trait)
Newborn Screening - 313
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 214 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E05-10333A
DOLOR en el Nino con Enfermedad de Celula Falciforme (Pain in the Child with Sickle Cell Disease)
Newborn Screening - 313
Electronic File
E05-10332A
Anemia De Celula Falciforme y Ataques (Sickle Cell Anemia and Stroke)
Newborn Screening - 313
Electronic File
E05-10328A
Crisis Aplastica (Aplastic Crisis)
Newborn Screening - 313
Electronic File
E05-03945A
Anemia de celulas falciformes: Una guia para padres de ninos en edad escolar
Newborn Screening - 313
Electronic File
E05-03880A
Crisis Aplastica (Aplastic Crisis)
Newborn Screening - 313
Electronic File
E05-03876A
Infeccion Neumococica y Penicilina (Pneumococcal Infection and Penicillin)
Newborn Screening - 313
Electronic File
E05-10327A
Priapismo (Priapism)
Newborn Screening - 313
Electronic File
E05-03872A
Talasemia Falciforme Beta+ (Sickle Beta+ Thalassemia)
Newborn Screening - 313
Electronic File
Skin & Skin Diseases / Piel y Enfermedades de la piel ECD-011-Span
Raspadura de la Piel para Casos o Sospechosos de la Enfermedad de Hansen’s
Infectious Disease - 629
Electronic File
E6-3A
Que hacer con su infeccion de la piel (What to do about your skin infection)
Infectious Disease - 400
Electronic File
E59-12490A
Preguntas Y Respuestas Infecciones de la piel por Staphylococcus aureus resistentes a los antibiotic
Infectious Disease - 703
Electronic File
CD-001A
Medicamento Como Terapia Para el Tratamiento de la Enfermedad de Hansen
Hansen's Disease - 83
Forms
5-13PA
El tomar una buena ofensiva aun es la mejor defensa! (A Good Offense is Still the Best Defense)
Warehouse
Posters
ECD-001A
Medicamento Como Terapia Para el Tratamiento de la Enfermedad de Hansen
Infectious Disease - 629
Electronic File
E6-5A
Impetigo
Infectious Disease - 184
Electronic File
ECD-010A
Biopsia de la Piel para Casos o Sospechosos de la Enfermedad de Hansen
Infectious Disease - 629
Electronic File
Smoking & Smokeless Tobacco / Fumar y Tabaco sin humo 16-11949P
My Family Doesn't Smoke Poster
Substance Abuse Services - Posters Tobacco - 25
Social Work / Trabajo social E77-11356A
Guia para el consumidor: licencia para el trabajador social (Consumer's Guide to Social Work Licens)
Tx State Bd of Social Worker Examiners - 358
Electronic File
Access to Recovery - 530
Electronic File
Nutrition Services - 570
Electronic File
Substance Abuse / Abuso de sustancias E103-12185A
Acceso a la Recuperacion a Traves de los Tribunales de Drogas (Access to Recovery/Drug Courts)
Teenage Pregnancy / Embarazo adolescente E13-102A
Dale a tu Bebe el mejor Cominezo
Texas Department of State Health Services / Departamento Estatal de Servicios de Salud de Texas MH-2A
El Cuidado de la Salud Mental (Taking Care of Your Mental Health)
Mental Health - 499
Electronic File
Tuberculosis / Tuberculosis ETB-411A
Formulario de declaraciones y aceptacion tratamiento de la tuberculosis
Infectious Disease Control Unit - TB - 320
Electronic File
EF12-11494A
Cuestionario de Tuberculosis [TB Questionnaire (Spanish)]
Infectious Disease Control Unit - TB - 320
Electronic File
TB-415A
Formulario de consentimiento tratamiento para la infección de tuberculosis latente
Warehouse
Forms
Stock #4-25-lang Revised 10/25/2010
Page 215 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
TB-619
Registro de Tratamiento (Treatment Record)
Infectious Disease Control Unit - TB - 253
Forms
TB-620
Registro de Tratamiento Preventivo (Preventive Treatment Record)
Infectious Disease Control Unit - TB - 253
Forms
ETB-410A
Orden para Implementar y Llevar a Cabo Medidas Para un Paciente con Tuberculosis
Infectious Disease Control Unit - TB - 320
Electronic File
TB-411A
Formulario de declaraciones y aceptacion tratamiento de la tuberculosis
Warehouse
Forms
ETB-415A
Formulario de consentimiento tratamiento para la infeccion de tuberculosis latente
Infectious Disease Control Unit - TB - 320
Electronic File
ETB-409A
Reconocimiento de Entendimiento Disposicion de Drogas Antituberculosas Limitadas para Clientes-TB
Infectious Disease Control Unit - TB - 320
Electronic File
Communications- 517
Electronic File
Weight Control / Control de peso E40465
Creando Familias Sanas (Building Healthy Families)
Women - Health & Hygiene / Mujeres--salud e higiene 1-451A
Descargar una copia del Directorio de Recursos del Derecho de la Mujer a la Informacion (max. 100)
Warehouse
Directories
E25TAC601.8(2)
Divulgacion de informacion y consentimiento para histerectomia
Health Facility Licensing 635
Electronic File
E10-70A
Paso a Paso-En apoyo de la salud de la mujer hispana a cada paso de su vida
Osteoporosis - 225
Electronic File
E10-72A
El Secreto de la nueva vida de Maria (The Secret of Maria's New Life)
Osteoporosis - 225
Electronic File
E1-450A
Descargar una copia del Material Informativo del Derecho de la Mujer a la Informacion
Perinatal/Maternal/Child 456
Electronic File
E1-451A
Descargar una copia del Directorio de Recursos del Derecho de la Mujer a la Informacion
Perinatal/Maternal/Child 456
Electronic File
Women, Infants, & Children Program / Programa de Nutricion Suplementaria para Mujeres, Bebes y Ninos 13-06-12408-11A
Encuestra de la leccion sobre la lactnacia maternal (Restricted to WIC Local agencies)
Bulletin Board
13-06-12365-2A
El Ejercicio ayuda a los ninos a: (Child's Play Bulletin Board)
Bulletin Board
13-163A
Llevese uno (Just Take One)
Posters
13-06-12579A
Zobey Magnet: Sabe usted los ninos necesitan (Restricted to WIC local agencies)
Magnets
13-06-12408-2A
Su bebe puede digerir la leche maternal (Restricted to WIC Local agencies)
Bulletin Board
E13-06-13120A
Su estancia en el hospital: que esperar y como hacerla inolvidable (The Hospital Experience: What to
13-06-12408-3A
Alimentar con pecho es bueno para la salud de las mamas (Restricted to WIC Local agencies)
Bulletin Board
13-06-12408-4A
Peinsa regresar al trabajo o a la escuela? (Restricted to WIC Local agencies)
Bulletin Board
13-06-12408-5A
Alimentar con pecho es conveniente (Restricted to WIC Local Agencies)
Bulletin Board
13-06-12408-12A
Dele un buen comienzo a la lactancia (Restricted to WIC Local agencies)
Bulletin Board
EGD-000-04A
Bienvenido a la clase de Zowzoo
13-06-12365-1A
Juego de Ninos (Child's Play Bulletin Board Title Piece)
Bulletin Board
13-06-13404A
Se permite amamantar bienvenida (window clings) (restricted to WIC Local Agencies)
Window clings
Stock #4-25-lang Revised 10/25/2010
Nutrition Services - 809
Nutrition Services - 415
Electronic File
WIC Lesson/TrainingElectronic
Page 216 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
13-06-12233A
Como saber si su recien nacido esta tomando suficiente leche materna(Restrict to WIC Local Agencies)
Magnets
13-186A
Pregunte Sobre Nuestro Programa de WIC
Posters
13-25-1A
Boy Crib Card
Nutrition Services - 885
Small card
13-25-2A
Girl NICU Crib Card
Nutrition Services - 885
Small card
13-25-3A
Boy NICU Crib Card
Nutrition Services - 885
Small card
13-25A
Girl Crib Card
Nutrition Services - 885
Small card
E13-06-11288A
Especialmente para los abuelos (Just For Grandparents)
Nutrition Services - 809
Electronic File
E13-06-11342A
Manual de dar pecho para las consejeras companeras de WIC
Nutrition Services - 150
Electronic File
E13-06-11934A
Soy un papa orgulloso (I'm A Proud Dad) (poster)
Nutrition Services - 570
Electronic File
13-06-13082A
Que le Interesa? (What Interests You?) poster
EWIC-35-3A
Cuestionario del programa WIC sobre los ingresos (WIC Income Questionnaire)
Nutrition Services - 401
Electronic File
E13-206A
Como sacar la leche materna a mano y como guardarla (Hand Expression and Storage of Breastmilk)
Nutrition Services - 809
Electronic File
E13-179A
Alimentar con pecho en publico
Nutrition Services - 809
Electronic File
EWIC-34-3A
Guia de compra de frutas y verduras de WIC de Texas
Nutrition Services - 824
Electronic File
EWIC-35-1A
Forma de informacion adicional Oportunidad de registrarse para votar-Forma NVRA-WIC
Nutrition Services - 401
Electronic File
E13-58A
Un Lugar de Trabajo que Apoya a las Mamas (Become a MotherFriendly Worksite)
Nutrition Services - 809
Electronic File
E13-06-12038A
Como se si estoy produciendo suficiente leche? (How Do I Know if I am Making Enough Milk?)
Nutrition Services - 570
Electronic File
E13-06-13331A
La Lactancia materna despues de los 6 meses
Nutrition Services - 809
Electronic File
E13-06-13182A
El apoyo que usted necesita Consejeras companeras de WIC para amamantar con exito
Nutrition Services - 809
Electronic File
13-06-12287A
Breastmilk: 100% Natural Ingredients (Bib) (restricted to WIC Local Agencies)
E13-06-13181A
Promueva la lactancia materna Sea una consejera companeras de WIC Enriquezca la vida de los demas
13-06-12365-13A
Juego de Ninos cuestionario (Child's Play Client Questionnaire)
E13-46A
Leche materna para bebes prematuros (Mother's Milk For Premature Babies)
Nutrition Services - 570
Electronic File
WIC-35-3A
Proof of Income (WIC)
Nutrition Services - 885
Forms
EWIC-42A
Historia de salud alimentaria para bebes
Nutrition Services - 730
Electronic File
E13-06-13124A
Paqueles de alimentos de WIC para Mamas y Bebes
Nutrition Services - 809
Electronic File
EWIC-44A
Historia medica para ninos (Health History for Children)
Nutrition Services - 730
Electronic File
EWIC-45A
Historia medica para jujeres embarazadas/pospartos/que amamantan
Nutrition Services - 730
Electronic File
13-06-11934A
Soy un papa orgulloso (I'm A Proud Dad) (poster)
Posters
Infant Bib Nutrition Services - 809
Electronic File Bulletin Board
Posters Posters
13-06-12262A
Hey Look What I can Do (poster)
E13-101A
La alimentacion con pecho y la planificacion familiar (Breastfeeding and Family Planning)
13-06-12365-12A
Juego de ninos cuestionario del participante survey (Child's Play Participant Survey)
Bulletin Board
F13-06-13103A
Registro de uso del sacaleches (Breast Pumping Log)
Forms
Nutrition Services - 809
Electronic File
Zoonoses / Zoonosis E7-36A
Informacion Sobre La Peste (Facts About Plague)
Zoonosis - 376
Electronic File
E7-39A
Murcielagos y rabia postar para escuelas
Zoonosis - 376
Electronic File
Stock #4-25-lang Revised 10/25/2010
Page 217 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
7-39A
Murcielagos y rabia postar para escuelas
Warehouse
Posters
7-38A
Aviso Sobre la Peste (Plague Warning) (poster)
Warehouse
Posters
7-26A
Rabies Poster
Warehouse
Posters
E7-7A
Encefalitis (Encephalitis)
Zoonosis - 376
Electronic File
Vietnamese Breastfeeding / Alimentacion con pecho E13-184V
Mother's Milk: It's More Than Just Food
Nutrition Services - 809
Electronic File
E13-197V
Eating For You--And a Healthy Baby, Too
Nutrition Services - 802
Electronic File
E13-220V
Breastfeeding An Instructional Guide for Giving Your Baby the Best
Nutrition Services - 570
Electronic File
ESP-000-06V
A Helping Hand for Breastfeeding Moms
Nutrition Services - 420
WIC Lesson/TrainingElectronic
E13-06-13331V
Breastfeeding Beyond Six Months?
Nutrition Services - 416
Electronic File
Case Management - 309
Electronic File
Texas Health Steps - 24
Electronic File
Case Management / Administracion de casos CPW-12V
Case Management Authorization to Disclose Protected Health Information
Children - Care & Hygiene / Ninos--su cuidado e higiene personal EPSDT-15A
Case Management for Children and Pregnant Women (Case Management Poster) 8-1/2" x 11"
Children - Nutrition / Ninos--su nutricion E13-196V
Tips for Feeding 1 to 3 years old
Nutrition Services - 802
Electronic File
E13-198V
Tips for Feeding 4 to 6 Year Olds
Nutrition Services - 802
Electronic File
#Controlling Diabetes One Day at a Time (Limit 5)
Warehouse
Videocassette
Controlling Diabetes One Day at a Time (Limit 5)
Warehouse
DVD
Texas Health Steps - 24
Electronic File
Nutrition Services - 802
Electronic File
What to Bring to Your WIC Appointment
Nutrition Services - 803
Electronic File
EWIC-35-3V
WIC Income Questionnaire
Nutrition Services - 803
Electronic File
EWIC-35V
Family Certification Form
Nutrition Services - 803
Electronic File
EWIC-42V
Health History for Infants
Nutrition Services - 803
Electronic File
EWIC-45V
Diet History for Pregnant/Breastfeeding/Postpartum Women
Nutrition Services - 803
Electronic File
TB-617
Preventive Treatment Record
Infectious Disease Control Unit - TB - 253
Forms
TB-618
Treatment Record
Infectious Disease Control Unit - TB - 253
Forms
EWIC-44V
Health History for Children
Nutrition Services - 803
Electronic File
CPW-12V
Case Management Authorization to Disclose Protected Health Information
Case Management - 309
Electronic File
EF14-13230V
Use and Storage of Newborn Screening Bloodspot Cards (Directive to Destroy)
Labs - 819
Electronic File
Diabetes / Diabetes BCD VIDV 10-21DVDV
Ears & Hearing Disorders / Oidos y Trastornos de audicion E1-186V
Make Sure Your Baby Can Hear the Sounds of Texas
Food Safety & Hygiene / Seguridad alimenticia e Higiene E13-06-12145V
Food Safety Guidelines for Women
Forms / Formularios EWICR14V
Stock #4-25-lang Revised 10/25/2010
Page 218 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
Forms-Eligibility / Formularios--elegibilidad EWIC-35-3V
WIC Income Questionnaire
Nutrition Services - 803
Electronic File
EWIC-35V
Family Certification Form
Nutrition Services - 803
Electronic File
EWICR14V
What to Bring to Your WIC Appointment
Nutrition Services - 803
Electronic File
Genetics / Genetica E1-319V
What Parents Want to Know About Newborn Screening: From Their Baby's Health Professional
Newborn Screening - 68
Electronic File
E1-63V
Newborn Screening: For Your Baby's Health
Newborn Screening - 68
Electronic File
Infants - Care & Hygiene / Bebes--su cuidado e higiene E1-63V
Newborn Screening: For Your Baby's Health
Newborn Screening - 68
Electronic File
E1-319V
What Parents Want to Know About Newborn Screening: From Their Baby's Health Professional
Newborn Screening - 68
Electronic File
E13-170V
Weaning Your Baby From the Bottle
Nutrition Services - 802
Electronic File
Make Sure Your Baby Can Hear the Sounds of Texas
Texas Health Steps - 24
Electronic File
E1-186V
Infants - Nutrition / Bebes--su nutricion E13-170V
Weaning Your Baby From the Bottle
Nutrition Services - 802
Electronic File
EIF-000-16V
Baby's First Spoonful: Tips for Starting Solids
Nutrition Services - 416
WIC Lesson/TrainingElectronic
E13-168V
Let's Eat: Food For Baby's First Year
Nutrition Services - 802
Electronic File
E1-63V
Newborn Screening: For Your Baby's Health
Newborn Screening - 68
Electronic File
E13-06-12255V
For Healthy Babies, Handle Bottles Safely
Nutrition Services - 802
Electronic File
Laboratories & Laboratory Safety / Laboratorios y Seguridad de laboratorios EF14-13230V
Use and Storage of Newborn Screening Bloodspot Cards (Directive to Destroy)
Labs - 819
Electronic File
Osteoporosis - 225
Electronic File
Nutrition Services - 804
Electronic File
Texas Health Steps - 24
Electronic File
Mental Hlth-Substance Abuse - 670
Electronic File
Osteoporosis - 225
Electronic File
Texas Health Steps - 24
Electronic File
Nutrition Services - 802
Electronic File
Lifestyles & Health / Estilos de vida y Salud E10-76V
Remember When Your Mother Used To Say "Just Drink This, It's Good For You?"
Medicare/Medicaid / Medicare/Medicaid E13-156V
A Guide to Helpful Programs and Services that WIC wants you to know about
Medicine / Medicina EPSDT-15A
Case Management for Children and Pregnant Women (Case Management Poster) 8-1/2" x 11"
Mental Health / Salud mental E16-9V
Handbook of Consumer Rights - Mental Health Services
Minority Health / Salud de minorias E10-76V
Remember When Your Mother Used To Say "Just Drink This, It's Good For You?"
Nursing / Enfermeria EPSDT-15A
Case Management for Children and Pregnant Women (Case Management Poster) 8-1/2" x 11"
Nutrition / Nutricion E13-197V
Eating For You--And a Healthy Baby, Too
Stock #4-25-lang Revised 10/25/2010
Page 219 of 221
Stock Number
Title
Format
Source (must print Contact List to have all necessary information)
E13-169V
Eat Well Be Well
Nutrition Services - 802
Electronic File
E13-06-12145V
Food Safety Guidelines for Women
Nutrition Services - 802
Electronic File
E13-66V
Healthy Moms, Healthy Babies
Nutrition Services - 802
Electronic File
E13-182V
New MyPyramid.gov−Steps to a Healthier You (NEW Food Guide Pyramid)
Nutrition Services - 802
Electronic File
Osteoporosis - 225
Electronic File
Osteoporosis / Osteoporosis E10-76V
Remember When Your Mother Used To Say "Just Drink This, It's Good For You?"
Patient/Client Records / Archivos de pacientes/clientes TB-617
Preventive Treatment Record
Infectious Disease Control Unit - TB - 253
Forms
TB-618
Treatment Record
Infectious Disease Control Unit - TB - 253
Forms
Prenatal & Postpartum Care / Cuidado prenatal y posparto EPSDT-15A
Case Management for Children and Pregnant Women (Case Management Poster) 8-1/2" x 11"
Texas Health Steps - 24
Electronic File
E13-197V
Eating For You--And a Healthy Baby, Too
Nutrition Services - 802
Electronic File
E13-66V
Healthy Moms, Healthy Babies
Nutrition Services - 802
Electronic File
Tuberculosis / Tuberculosis TB-617
Preventive Treatment Record
Infectious Disease Control Unit - TB - 253
Forms
TB-618
Treatment Record
Infectious Disease Control Unit - TB - 253
Forms
Osteoporosis - 225
Electronic File
Women - Health & Hygiene / Mujeres--salud e higiene E10-76V
Remember When Your Mother Used To Say "Just Drink This, It's Good For You?"
Women, Infants, & Children Program / Programa de Nutricion Suplementaria para Mujeres, Bebes y Ninos Diet History for Pregnant/Breastfeeding/Postpartum Women
Nutrition Services - 803
Electronic File
E13-55V
Texas WIC Reference Guide
Nutrition Services - 804
Electronic File
E13-66V
Healthy Moms, Healthy Babies
Nutrition Services - 802
Electronic File
E13-92V
WIC Is Growing Healthy Families
Nutrition Services - 804
Electronic File
E13-3V
Welcome to WIC
Nutrition Services - 802
Electronic File
E13-220V
Breastfeeding An Instructional Guide for Giving Your Baby the Best
Nutrition Services - 570
Electronic File
E13-182V
New MyPyramid.gov−Steps to a Healthier You (NEW Food Guide Pyramid)
Nutrition Services - 802
Electronic File
E13-169V
Eat Well Be Well
Nutrition Services - 802
Electronic File
E13-156V
A Guide to Helpful Programs and Services that WIC wants you to know about
Nutrition Services - 804
Electronic File
E13-06-13331V
Breastfeeding Beyond Six Months?
Nutrition Services - 416
Electronic File
E13-06-12894V
Keep Your Family Healthy
Nutrition Services - 802
Electronic File
E13-06-12255V
For Healthy Babies, Handle Bottles Safely
Nutrition Services - 802
Electronic File
EWICR14V
What to Bring to Your WIC Appointment
Nutrition Services - 803
Electronic File
EWIC-35-3V
WIC Income Questionnaire
Nutrition Services - 803
Electronic File
EIF-000-16V
Baby's First Spoonful: Tips for Starting Solids
Nutrition Services - 416
WIC Lesson/TrainingElectronic
EWIC-45V
Stock #4-25-lang Revised 10/25/2010
Page 220 of 221
Stock Number
Title
Source (must print Contact List to have all necessary information)
Format
EWIC-44V
Health History for Children
Nutrition Services - 803
EWIC-42V
Health History for Infants
Nutrition Services - 803
Electronic File
ESP-000-06V
A Helping Hand for Breastfeeding Moms
Nutrition Services - 420
WIC Lesson/TrainingElectronic
EWIC-34-1V
Shopping Guide for Formula Fed Infants
Nutrition Services - 824
Electronic File
EWIC-34-2V
Shopping Guide for Exclusively Breastfed Infants
Nutrition Services - 824
Electronic File
EWIC-34-3V
Shopping Guide for Fruits and Vegetables
Nutrition Services - 824
Electronic File
EWIC-34V
Texas WIC Approved Foods
Nutrition Services - 805
Electronic File
EWIC-35-1V
Supplemental Information Form (SIF)
Nutrition Services - 803
Electronic File
EWIC-35V
Family Certification Form
Nutrition Services - 803
Electronic File
Food Safety Guidelines for Women
Nutrition Services - 802
Electronic File
E13-06-12145V
Stock #4-25-lang Revised 10/25/2010
Electronic File
Page 221 of 221
