Loading
Get Tx Dads 3613-a 2012-2025
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the TX DADS 3613-A online
Completing the TX DADS 3613-A form is essential for reporting incidents in various healthcare facilities. This guide offers step-by-step instructions to help users fill out the form correctly and efficiently.
Follow the steps to accurately complete the TX DADS 3613-A form.
- Press the ‘Get Form’ button to access the TX DADS 3613-A and open it for editing.
- Begin by filling out the fax cover sheet. Enter the date, recipient details, including the DADS Consumer Rights and Services Section, and the fax area code and telephone number.
- Complete the Provider Investigation Report section by entering the agency name, license number, and address details, including city, state, and ZIP code.
- Indicate the category of incident among the provided options such as death, abuse, neglect, and various emergencies. Specify if the allegation relates to an individual, family, or another source.
- Fill in the details of individuals involved in the incident, including names, gender, Social Security numbers, birth dates, and their level of functional ability and supervision.
- Provide information about the alleged perpetrator, including their name, relationship to the individual, and how they were identified.
- Document the description of the allegation, including any injuries or adverse effects observed.
- Sign the form, and include your title and printed name along with the date.
Complete the TX DADS 3613-A form online today to ensure proper incident reporting.
The fax number for Texas Health and Human Services is (512) 424-6508. Use this number to send documents related to TX DADS 3613-A or other requests. It’s important to include a cover sheet with your contact information to ensure a swift response.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.