Claim Forms Indexes
Texas Healthcare Foundation
Company

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  Our Savings
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  Our References
  Our Cooperative Medical Provider Directory
  What is Nonsubscription?

Claims Management
  Our Claims Management Program
  Our Claims Management Forms
  Claims Management System
Medical Bill Review
  Our Medical Bill Review Program
  Medical Bill Review System
Links
  Texas Association of Responsible Nonsubscribers (TXANS)
  Overview of Nonsubscription
  Nonsubscription FAQ's
  History of TXANS
  Nonsubscriber Newscast
  Join TXANS
  CrossPoint
  Texas Department of Insurance Division of Workers' Compensation (DWC)

 

Please click on the form link to download.

THF Generic Forms
 Instructions for reporting claims to THF  
 All 6 forms in one .PDF file download  
 Form 1 - Employee Statement of Injury 
 Form 2 - Witness Statement 
 Form 3 - Supervisor's Incident / Investigation 
 Form 4 - Medical Treatment Authorization 
 Form 5 - Physician's Report of Employee Injury 
 Form 6 - Medical Records Release Authorization 
Links to the Texas Department of Insurance
Division of Workers' Compensation (DWC) Forms
 Employer Non-Coverage Package, PDF Format
 Notice 5 (English)   must be posted for employees to read
 Notice 5 (Spanish)  must be posted for employees to read
 Notice 5 Rules
 DWC-5 Form (English) (includes instructions) Required Annually
 DWC-5 Form (Spanish) (includes instructions) Required Annually
 Locations of Employer's Business(es)
 DWC-7 Form (includes instructions)
 Supplement DWC-7
 New Employee Notice
 New Employee Notice (Spanish)
 Insurance Carrier Notice of Coverage/Cancellation/Non-Renewal of Coverage
Federal Forms Links
 Link to OSHA Publications
 Link to OSHA 300 Publications
Miscellaneous File Links
 Crystal Reports 8.5 ActiveX (Rename .pdf to .exe)
Just Call Copyright C
Texas Healthcare Foundation
1278 FM 407, Suite 105
Lewisville, Texas 75077-2200
ph: 800-716-6777 - 972-317-1252
fax: 972-317-0889		 TXANS logo