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Texas Income Protection Plan for State Employees, ERS


Behavioral Health Clinician Statement

The Behavioral Health Clinician Statement will be completed by your treating provider and will give us medical information regarding your date of disability, the diagnosis, the return to work date and any follow-up treatment. The BH APS is only required when your claim is due to a Behavioral Health condition. The original BH APS form must be completed and signed by a licensed MD or DO in the medical field and faxed or mailed to TIPP Customer Care (fax number and address are shown on the form).

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