Form 8802 AR 2018-2025

Form 8802 AR: What You Should Know

CES-3 Form This form is intended for use by the Texas Department of State Health Services. CES-3 is only used if you have suffered physical or psychological injury during pregnancy or if you have caused or contributed to injury to a child while being pregnant. CES-3 form is only used by licensed health professionals. If you require additional or more detailed information, please contact the Texas Attorney General's Division of Health and Human Services. TDD: 1-877-98CES-3 (5256) This form is intended for use by the Texas Department of Community Health, Texas Department for Aging & Disability Services, Texas Health and Human Services Commission, Texas Office of Attorney General, Texas Department of Family and Protective Services, Texas Environmental Protection Agency, Texas Office of the State Surgeon General, Texas Department of State Health Services, and Texas Department of Public Safety to collect data on birth defects, certain disabilities, fetal loss/preservation and related factors in Texas. Use of the Texas Health & Safety Code (HHSC), Chapter 1231, Part 4 of Texas Family Code, as well as the Family Code Part 5, Subpart 1, Subsection A as a source of information to determine the source of the defect(s). Use of Section 1-103.02 of the Health and Safety Code, Chapter 1231, Part 4 of Texas Family Code, as a source for medical documentation or other documentation for determining the diagnosis and extent of the condition and the potential effects on the fetus. CES-3 Form This form is intended for use by the Texas Department of State Health Services. CES-3 is only used if you have suffered physical or psychological injury during pregnancy or if you have caused or contributed to injury to a child while being pregnant. CES-3 form is only used by licensed health professionals. If you require additional or more detailed information, please contact the Texas Attorney General's Division of Health and Human Services. TDD: 1-877-98CES-3 (5256) This form is intended for use by the Texas Department of State Health Services. CES-3 is only used if you have suffered physical or psychological injury during pregnancy or if you have caused or contributed to injury to a child while being pregnant. CES-3 form is only used by licensed health professionals.

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