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Texas Healthcare Foundation
Company

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


We encourage our customers to take advantage of all of the simple interactive tools on our website. Incident reports and state and federal reporting and notice forms applicable to all Nonsubscribers are easily downloaded by clicking on the links below. For a personal demonstration to see which of our tools best fit your needs, just call THF at 800-716-6777. We'll be glad to help.

Please click on the form link to download.

THF's Incident Reports
 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
 DWC-5 Form (English) (includes instructions) Required Annually
  DWC-5 Form File On-Line  
 DWC-5 Form (Spanish) (includes instructions) Required Annually
 DWC-205 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 11.5 ActiveX (Rename .pdf to .msi)

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
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