Get Tx Notification Of No Quarterly Data To Report To Thcic 2015-2025

This guide provides a comprehensive overview of how to fill out the TX Notification of No Quarterly Data to Report to THCIC online. It is designed to assist users of all backgrounds in completing the form accurately and efficiently.

Follow the steps to complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the date in the designated field. Ensure the date format is consistent and clear.
3. Provide the facility name in the appropriate section. This should reflect the registered name of the healthcare facility.
4. Fill in the facility address, including street, city, state, and zip code. Accuracy is important for proper identification and contact.
5. Input the facility THCIC ID number in the specified field. This number is essential for associating the report with the correct facility.
6. Indicate the reporting quarter and year (for example, 1Q15). Make sure to match the format required for correct processing.
7. Check the boxes that apply to acknowledge that there were either no inpatient discharges or no emergency department or outpatient surgical and/or radiological services for the reporting quarter.
8. Print the name of the administrator or CEO in the designated area and ensure it is legible.
9. Obtain the signature of the administrator or CEO in the specified field; this is mandatory.
10. Provide the email address of the administrator or CEO in the relevant field for communication purposes.
11. Fax the completed form to THCIC at 512-776-7740 no later than the reporting quarter’s scheduled reporting date.
12. After completing the form, save your changes, then you can download, print, or share the document as needed.

Complete your documents online with ease and ensure timely reporting.