Web(2) A facility must submit a Form 3613-A Provider Investigation Report, minus the name of the person who tested positive for COVID-19, to HHSC Complaint and Incident Intake, through TULIP, by email at [email protected], or by fax at 877-438-5827, within five working days from the day a confirmed case is reported to CII. WebTo be in compliance with regulatory requirements, you must email, fax, or mail a completed HHS Provider Investigation Report Form (Form 3613-A or 3613) according to your …
Section 559.241 - Reporting Abuse, Neglect, Exploitation, or …
WebThe Health and Safety Code (HSC), Chapter 142 authorizes the Texas Health and Human Services Commission (HHSC) to adopt a minimum standard that a person or entity must meet in order to be licensed as a Home and Community Support Services Agency (HCSSA) and to qualify to provide certified Home Health Services. WebIf Form 3613-A, with statements and other relevant documentation, is 15 pages or fewer, email [email protected] or fax the report and attachments toll-free to HHSC at 1 … download office standalone
3613A - Fill Out and Sign Printable PDF Template signNow
WebOnce you submit a self-report, you will receive a report identification number that starts with “SR.” Use this identification number when you submit your Provider Investigation Report (Form 3613/ 3613-A). If you would like to keep a copy of your submission report, please click “Print Report.” Email questions to [email protected] WebFill out your hhsc form 3613 with a selection of necessary blank fields. Note all of the important information and ensure there is nothing left out! 2. The third part is usually to fill out the next few blanks: City State ZIP Code, County, Area Code and Telephone No, Fax Area Code and Telephone No, Parent, BranchAlternate Delivery Site ... WebForm 3613 / 10-2008 Texas Department of Aging and Disability Services Provider Investigation Report Form 3613 October 2008 For Home and Community Support Services Agency (or Home Health and Hospice) Provider use only. Fax this report to: 1-877-438-5827 (If 15 total pages or fewer) Note to reporter: Do not mail if faxed. download office standard 2021