Texas Health Steps Request for Material - …

1 Texas Health StepsRequest for MaterialShip materials to: (please print clearly)Contact Person:Company/Agency:Telephone: ( _____ ) _____ Ext. _____Fax: ( _____ ) _____Email Address: _____Send completed form to:THSteps Products ManagementFax: 512-533-3860 Email: 512-919-1623 Online: items may be limited due to State requirements. You will be notified of items on back order. Balance due will be shipped when available unless otherwise Management Materials(Please provide physical address - we cannot ship to PO Boxes)Form THSPM-1 (01/19)Stock NumberDescriptionQuantity Ordered1-322 Hearing Screening Result Fact Sheet (English)1-322 AHearing Screening Result Fact Sheet (Spanish)1-323 Hearing Checklist Fact Sheet (English)1-323 AHearing Checklist Fact Sheet (Spanish)

2 1-325 Newborn Hearing Screening Brochure1-326 Genetics and Hearing Brochure1-327 After The Hearing Screen Brochure1-328A Roadmap For Families1-334 Quick Reference Guide for Audiologists1-335 Quick Reference Guide For Physicians1-336 Quick Reference Guide for Screeners1-337 Managing, Tracking and Reporting Data in the TEHDI1-338 TEHDI Bookmark1-338 ATEHDI Bookmark (Spanish)1-342 Texas Early Hearing Detection and Intervention1-343 Texas Early Hearing Detection and Intervention05-122581-3-6 Month Practitioner s Guide05-13581 Just In Time: Resources for Audiologists Booklet05-13597 Newborn Hearing Screening: For Midwives Fact Sheet05-13598 TEHDI FAQs05-13599 Information for Health Professionals BrochureNewborn Hearing Screening Program MaterialsStock NumberDescriptionQuantity OrderedEPSDT-04 Desk Reference (Staff)EPSDT-05 Don t Miss A Beat (English/Spanish)EPSDT-05 ADon t Miss A Beat (English/Vietnamese)EPSDT-05 TDon t Miss A Beat-Teen Brochure (English/Spanish)EPSDT-08 Checkups Help Children Stay Healthy!

3 (English/Spanish)EPSDT-08 ACheckups Help Children Stay Healthy! (English/Vietnamese)EPSDT-10 Brush Up On Healthy Habits-Poster (English)EPSDT-10 SBrush Up On Healthy Habits-Poster (Spanish)EPSDT-12 Don t Miss A Beat-Poster (English)EPSDT-12 SDon t Miss A Beat-Poster (Spanish)EPSDT-13 Keep Your Child s Checkups in CheckEPSDT-13 SKeep Your Child s Checkups in CheckEPSDT-16 Keep Your Child s Checkups in Check (English/Spanish)EPSDT-16 AKeep Your Child s Checkups in Check (English/Vietnamese)EPSDT-16 TKeep Your Checkups in Check -TEEN BROCHURE (English/Spanish)EPSDT-25 Good Health . Healthy Travels (Bilingual)EPSDT-26 Brush Up On Healthy Habits-Teen BrochureDental 8-17 Brush Up On Healthy HabitsDental 8-20 Dental Flip Chart (English)Dental 8-20 SDental Flip Chart (Spanish)E08-12876 Dental Anticipatory Guide (English)E08-12876 ADental Anticipatory Guide (Spanish)E08-12877 Keep Your Child Smiling Brochure08-13373 First Dental Home Desk Reference (English)E03-13591 The Benefits of Fluoride Varnish Poster (English)E03-13592 Stages of Tooth Decay Poster (English)E03-13593 Sealants and Fluoride Varnish Poster (English)MTP-110 Medicaid - Free Rides to the Doctor Brochure (Eng/Spa)MTP-210 Medicaid - Free Rides Wallet Card (English)MTP-210 SMedicaid - Free Rides Wallet Card (Spanish)

4 MTP-310 Medicaid - Free Rides to the Doctor Poster (Eng/Spa)MTP-410 Medicaid - Free Rides to the Doctor Pushcard (Eng/Spa)MTP-510 Medicaid - Free Rides to the Doctor Desk Reference (Eng/Spa)MTP-610 Free Rides Sticker (English)MTP-610 SFree Rides Sticker (Spanish)Stock NumberDescriptionQuantity Ordered1-182 Case Management Program Brochure (English/Spanish)1-182 ACase Management Program Brochure (English/Vietnamese)1-220 Personal Care Services Help for Daily Living1-221 Community First Choice - Help for Daily LivingEPSDT-15 Case Management Program Poster (English)EPSDT-15 SCase Management Program Poster (Spanish)EPSDT-15 ACase Management Program Poster (Vietnamese)05-13684 Case Management Recruitment Flyer (English)05-13916 Case Management Referral Pad (English)05-14010 Case Management Referral Guide (English)