Texas notification no report 2026

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The document is a notification form from the Texas Department of State Health Services (DSHS) for facilities to report that they have no quarterly data to submit to the Texas Health Care Information Collection (THCIC) regarding inpatient discharges or outpatient services for a specified reporting quarter. It includes instructions for completion, relevant Texas Administrative Code references, and potential penalties for non-compliance.

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Click ‘Get Form’ to open the texas notification no report in the editor.
Begin by entering the 'Date' at the top of the form. This should reflect the date you are submitting the notification.
Fill in your 'Facility Name' and 'Facility Address' accurately to ensure proper identification.
Input your 'Facility THCIC ID Number' which is essential for tracking your submission.
Specify the 'Reporting Quarter/Year' using the format provided (e.g., 1q15).
Check all applicable boxes indicating whether there were no inpatient discharges or no emergency department/outpatient services for that quarter.
Print and sign your name as Administrator/CEO in the designated areas, and provide your email address for follow-up communication.
Finally, fax the completed form to THCIC at 512-776-7740 before the reporting deadline.

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2024	4.7 Satisfied (50 Votes)
2022	4.8 Satisfied (52 Votes)
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2020	4.4 Satisfied (58 Votes)