Helpful Forms & Links

Below are some helpful forms and links to other websites that may help you get well and stay well.

Forms

• Authorization to Disclose Health Information Form (PDF)
• Authorization to Disclose Health Information – Cancellation Form (PDF)
• Asthma Form (PDF)
• COPD Form (PDF)
• Coronary Artery Disease Form (PDF)
• Diabetes Form (PDF)
• Doctor Appointment Checklist (PDF)
• High Blood Pressure Form (PDF)
• High Cholesterol Form (PDF)
• Primary Care Provider (PCP) Change Request Form (PDF)
• Weight Management Form (PDF)

To help you make sure your child’s doctor has the information he or she needs when you visit, please fill out one of the forms below before you go to an appointment:

• 2-Month-Old Child Well-Visit Form (PDF)
• 4-Month-Old Child Well-Visit Form (PDF)
• 6-Month-Old Child Well-Visit Form (PDF)
• 9-Month-Old Child Well-Visit Form (PDF)
• 12-Month-Old Child Well-Visit Form (PDF)
• 15-Month-Old Child Well-Visit Form (PDF)
• 18-Month-Old Child Well-Visit Form (PDF)
• 24-Month-Old Child Well-Visit Form (PDF)
• 30-Month-Old Child Well-Visit Form (PDF)
• 3-Year-Old Child Well-Visit Form (PDF)
• 4-Year-Old Child Well-Visit Form (PDF)
• 5-Year-Old Child Well-Visit Form (PDF)
• 6-Year-Old Child Well-Visit Form (PDF)
• 7-Year-Old Child Well-Visit Form (PDF)
• 8-Year-Old Child Well-Visit Form (PDF)
• 9-Year-Old Child Well-Visit Form (PDF)
• 10-Year-Old Child Well-Visit Form (PDF)

Helpful Links

Below are some helpful resources you can use to find more information that may help you get well and stay well. Please note, these links will take you away from Superior’s website.

• AARP
• Academy of Nutrition and Dietetics
• American Academy of Pediatrics – HealthyChildren.org
• American Cancer Society
• American Heart Association
• American Lung Association
• BabyCenter.com
• Centers for Disease Control and Prevention
• Centers for Medicare and Medicaid Services (CMS)
• Children’s Advocacy of Texas
• CMS Best Available Evidence Policy
• CMS Plan Rating
• Department of Family and Protective Services (DFPS)
• Financial Literacy Guide (Office of Consumer Credit Commission)
• Friends and Family Guide to Adult Mental Health Services 
• ImmTrac – Texas Immunization Registry
• Kids Health from Nemours
• March of Dimes
• Mayo Clinic
• Medically Dependent Children Program (MDCP)
• MyStrength
• National Imaging Associates (NIA) RadMD
• Nutrition.gov
• Office of the Inspector General (OIG) – Report Fraud, Waste or Abuse
• Sickle Cell Disease Association of America
• SickleCellKids.org
• Siteman Cancer Center – Your Disease Risk
• Social Security Administration (SSA)
• STAR+PLUS Health & Human Services Commission (HHSC) website
• STAR Health Managed Care Contract
• Susan G. Komen for the Cure – About Breast Cancer
• Texas Department of State Health Services
• Texas Foster Family Association (TFFA)
• Texas Health and Human Services Commission Electronic Visit Verification (EVV) Rights and Responsibilities Form
• Texas Health and Human Services Notice about Reporting Medicaid Fraud (PDF)
• The Children’s Health Insurance Program (CHIP)
• The Hotline
• U.S. Department of Health & Human Services – healthfinder.gov
• United States Department of Agriculture – ChooseMyPlate.gov
• United States Department of Veterans Affairs