Get Tx Dshs Form 1. Nhsn (hai) Data Contacts

Filling out the TX DSHS Form 1. NHSN (HAI) Data Contacts is essential for maintaining accurate communications regarding healthcare-associated infections. This guide will provide you with step-by-step instructions to successfully complete the form online.

Follow the steps to easily complete your form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the facility name in the designated field. Ensure the name is accurate to avoid complications.
3. If applicable, enter the NHSN ID in the provided space. This identifier is essential for tracking your facility.
4. Provide the facility's physical address, including street, city, state, and zip code, in the appropriate section.
5. In the HAI Reporting Contacts section, identify the primary reporting contact. Fill in their name, title, telephone number, and email address in the required fields.
6. If applicable, complete the optional HAI Reporting Contact section. Include an additional contact's name, title, telephone number, and email address.
7. In the CEO/Admin Certification Statement, print the name of the approving CEO or administrative personnel in the specified area.
8. Obtain the CEO or other 'O' suite administrator’s signature along with the date on which the form is completed.
9. After filling out the form, ensure all information is accurate. You can save changes, download the document, print it, or share it as needed.
10. Lastly, email the completed form to HAITEXAS@dshs.texas.gov for processing.

Complete your TX DSHS Form 1. NHSN (HAI) Data Contacts online today!