Get - Dshs Texas

Filling out the DSHS Texas form online can streamline the process of reporting incidents and ensure that all necessary information is properly documented. This guide provides a clear set of instructions to assist users in completing the form accurately.

Follow the steps to fill out the DSHS Texas form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the reporting information section, indicate the type of incident being reported. Options include the death of a patient, ambulance transport, hepatitis B conversions, involuntary transfers, and fire incidents. Be sure to fill in the date and time of the incident.
3. For facility information, provide the facility license number, facility provider number, address, contact person, telephone number, email address, and fax number. Ensure the facility license number is correctly noted as it appears on your facility license.
4. In the summary section, briefly outline what transpired during the incident. Include who was involved and the actions taken at that time. If necessary, attach additional sheets for a detailed report.
5. Complete the narrative section with a report of your thorough investigation. Discuss how the incident was managed and detail the steps to be implemented to prevent similar occurrences in the future.
6. In the action section, check all applicable responses to describe the actions that will be taken as a result of the incident, including staff education and policy revisions.
7. If the incident involves a patient, complete the patient information section accurately, noting their first name, last name, date of birth, and current condition.
8. Fill out the treatment information, indicating the service type and access type. Document current dry weight and complete the required charts related to treatment and laboratory results.
9. If applicable, provide details about patient transfers, including the name of the facility and date of transfer, along with required supporting documents.
10. Finally, ensure the supervising nurse prints their name, title, signs, and dates the incident report. Once completed, submit the report via fax or mail to DSHS, making sure not to send multiple copies.

Complete your DSHS Texas form online today for efficient reporting.