Get Tx Dshs Form F25-11047 2013

This guide provides clear and concise instructions on completing the TX DSHS Form F25-11047 online for nonprofit hospitals. By following these steps, users can effectively report their charity care policies and community benefits, ensuring compliance with Texas Health and Safety Code requirements.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editing tool.
2. Fill in the facility identification number (FID) by entering the 7-digit FID# from the hospital listing attached to the form. Ensure accuracy to avoid processing delays.
3. Provide the hospital's name and county. For instance, enter 'East Texas Medical Center' and 'Camp'.
4. Complete the mailing address by entering the full address, ensuring all details are correct.
5. Indicate the effective date of the current charity care policy. For example, '11/01/2009' should be formatted to reflect your policy's date.
6. Specify how often your charity care policy is revised, selecting an option from the available choices, such as 'Annually'.
7. Provide the name and contact details of the office or department responsible for processing charity care requests, including the contact person's name and their phone number.
8. If a different person is completing the form, enter their name and phone number.
9. Document your hospital's charity care mission statement clearly in the provided space.
10. Answer all questions regarding the charity care policy, including definitions, eligibility criteria, and documentation requirements, ensuring all checks, options, and descriptions are accurately selected or filled out.
11. Review the information for accuracy and completeness in every section of the form.
12. Once finished, save the changes to your document. You have the option to download, print, or share the completed form as needed.

Take action now by completing the TX DSHS Form F25-11047 online to ensure your hospital's charity care policies are up to date.