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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2012 | 4.9 Satisfied (351 Votes) |
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This form is required to be filed by various healthcare facilities, including Skilled Nursing Facilities (SNF), Nursing Facilities (NF), Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID), Assisted Living Facilities (ALF), Adult Day Care Facilities (ADC), and Day and Activity Health Services Facilities (DAHS). For instance, if a resident in an SNF experiences neglect or abuse, the facility must complete this report to document the incident and notify the appropriate authorities. Additionally, it can be used when there are emergencies such as natural disasters affecting residents' safety.
The Provider Investigation Report must be submitted promptly following an incident, typically within a specified timeframe set by regulatory bodies. It is crucial to ensure that all necessary documentation, including details of the incident and any involved parties, is accurately filled out. The report should not be mailed if it has been faxed; instead, it should be sent via fax to the designated number provided by the Texas Department of Aging and Disability Services.
To submit Form 3613 a, first obtain the template from DocHub or your facility's records. Fill out all required fields accurately, ensuring that you include information about the incident, individuals involved, and any witnesses. Once completed, you can either fax it directly to the Consumer Rights and Services Section at the provided toll-free number or mail it to their office address in Austin. If you choose to fax it, remember not to send a physical copy through mail.
It is vital for facilities submitting this report to maintain confidentiality regarding sensitive information contained within. The report includes sections for detailing allegations against staff members or other individuals involved in incidents affecting residents. Furthermore, facilities should ensure they have protocols in place for training staff on how to handle such situations effectively before they arise.
