Form 1327, Growth Hormone Agents Standard PA Addendum (CSHCN)

Instructions for Opening a Form

Some forms cannot be viewed in a web browser and must be opened in Adobe Acrobat Reader on your desktop system. Click here for instructions on opening this form.


Effective Date: 9/2023


Updated: 03/2023


The Children with Special Health Care Needs (CSHCN) Services Program covers growth hormones for people with specific diagnoses involving growth hormone deficiency. If an initial or extension request cannot be approved based on the above criteria, the approval request may be sent for medical review and reconsideration to program staff for medical review and reconsideration.


When to Prepare

Prescribing providers only use this form for people enrolled in the CSHCN Services Program. A program-approved provider must complete and sign this form annually certifying that the individual requires these medications.

Providers should complete all requested information or document why the information is not available. Providers must submit Form 1327 and Texas Standard Prior Authorization Request Form for Prescription Drug Benefits.


Providers should send the form to the CSHCN-enrolled pharmacy, who then forwards the completed form by fax or mail:

Fax: 512-776-7238


Texas Health and Human Services  
Children with Special Health Care Needs Services Program  
Mail Code 1938  
P.O. Box 149030  
Austin, TX 78714-9947


Refer comments or questions about this form to the CSHCN Services Program at 800-252-8023.