Get Tx Hhs Form 1126 2011-2025

Filling out the TX HHS Form 1126 is an essential step for determining the appropriate placement of residents in assisted living facilities. This guide will provide you with clear instructions on how to complete the form online effectively.

Follow the steps to successfully complete the TX HHS Form 1126 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the facility in the designated field. This identifies the location responsible for the assessment.
3. Next, input the Facility ID, which helps in the administrative tracking of the document.
4. Enter the resident's name. Ensure that the name is accurate to avoid any confusion later.
5. Select the appropriate date in the section that applies, either the date the facility has determined the resident's placement is inappropriate or the date of the HHSC visit.
6. Document when the facility received Form 3724, which includes details about licensing violations and the plan for correction, by entering the relevant date.
7. Proceed to the section designated for the resident's physician. The physician must acknowledge the determination of inappropriate placement.
8. The physician will indicate whether they believe the resident is appropriately placed, referencing any necessary assessments and attaching supporting documents as needed. Key aspects to address include the resident's ambulation status, transfer capabilities, mental capacity, and medical condition.
9. Have the physician complete their name and signature to validate the assessment and confirm the content of the report.
10. Finally, select the date the form is completed, and ensure all necessary attachments are included.
11. Once you have filled out the form completely, proceed to save changes, download, print, or share the completed document as necessary.

Complete your TX HHS Form 1126 online today for an efficient submission process.