Get Life Safety Code Attestation For Exempt Esrd Facilities - Dshs Texas

This guide provides clear instructions on how to accurately complete the Life Safety Code Attestation for Exempt ESRD Facilities in Texas online. By following these steps, you will ensure that your facility meets necessary compliance requirements efficiently.

Follow the steps to complete your attestation form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. In the first section, enter the facility name in the designated field. Ensure that the name is spelled correctly to avoid any processing issues.
3. Next, fill in the facility address. Provide the complete address including street, city, state, and zip code.
4. Enter the license number in the given space. This number is unique to your facility and is essential for identification.
5. Fill in the Certification Number (CCN) as well. This number is necessary for compliance verification.
6. In the attestation section, confirm that your facility provides one or more exits to the outside at grade level from the patient treatment area. Ensure that you mention if an accessibility ramp is in place.
7. Acknowledge that your facility is not adjacent to any high hazardous occupancy by reading the provided definition and affirming your compliance.
8. Indicate your commitment to notify CMS if there are any structural changes that affect your exemption status.
9. Print the name of the facility administrator in the designated space. Make sure that it is clear and legible.
10. Include the date of completion in the field provided.
11. Finally, ensure the facility administrator signs the document to validate the attestation.
12. Once all fields are completed, save your changes. You can also download, print, or share the completed form as needed.

Complete your Life Safety Code Attestation online today to ensure compliance and safety for your facility.