|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The Health Facility Program is within the Division for Regulatory Services.
Health Facility Licensing
Reference Center |
Applications and Forms
|
|
This page contains applications, forms and directories pertaining to facility licensure . Refer to File Viewing Information on the left-hand side menu to download viewers for PDF files, MS Word documents and Excel files.
How to Become a Licensed Abortion Facility Application | Word File 61KB |
PDF File 31KB |
DSHS Vital Statistics Abortion report forms for physicians - Click here to link | ||
Disclosure and Consent form |
Locate PDF file at: 22 TAC §165.6(f) | |
Informed Consent Certification form | TAC §139.52(a)(1) - English | |
Affidavit of Age form | PDF File 7KB - Spanish | TAC ยง139.41(a)(8)(A) - English |
Information on Toll-Free Telephone Number | TAC §139.6(a)(2) - Spanish | TAC §139.6(a)(1) - English |
How to Become a Licensed Ambulatory Surgical Center Application |
Word File 61KB | PDF File 28KB |
Architectural Review Information and Forms - Click here to link | ||
Disclosure and Consent forms for medical and surgical procedures | ||
Incident Report form | PDF File 12KB | |
Annual Occurrence Report form | Word File 70KB | PDF File 40KB |
Best Practices Report form | Word File 36KB | PDF File 35KB |
Directories of Ambulatory Surgical Centers. Directories are updated on the 1st and 15th business day of each month. Revised date appears on first page of PDF listing. | Excel File 145KB | Alphabetical 69KB PDF By County 66KB PDF |
How to Become a Licensed Birthing Center Application | Word File 58KB | PDF File 741KB |
Directories of Birthing Centers Directories are updated on the 1st and 15th business day of each month. Revised date appears on first page of listing. |
Alphabetical 17KB PDF By County 33KB PDF |
Center for Medicare/Medicaid Services - Forms | Link to downloadable forms |
Center for Medicare/Medicaid Services - Overview | Link to general overview page |
How to Become a Licensed End Stage Renal Disease Facility Application | Word File 80KB | PDF File 41KB |
Architectural Review Information and Forms - Not mandatory for ESRDs - Click here to link | ||
Incident Report including instructions | PDF File 32KB | |
Application and Survey and Certification Report - CMS 3427- Link to downloadable forms | ||
Directories of End Stage Renal Disease Facilities |
Excel File 191KB |
Alphabetical By County |
How to Become a Licensed General or Special Hospital Application | Word File 236KB | PDF File |
Architectural Review Information and Forms - Click here to link | ||
Fire Safety Survey Report form | PDF File 39KB | |
Annual Occurrence Report form | Word File 62KB | PDF File 30KB |
Best Practices Report form | Word File 41KB | PDF File 28KB |
Hospital Closure and Change of Ownership Instructions | PDF File 32KB | |
Disclosure and Consent forms for medical and surgical procedures | ||
Hospital Waiver Request | PDF File 37KB | |
Directories of General & Special Hospitals
Directories are updated on the 1st and 15th business day of each month. Revised date appears on first page of PDF listing. |
Excel File 357KB | Alphabetical |
How to Become a Licensed Psychiatric Hospital or CSU Application | Word File 348KB | PDF File 119KB |
Architectural Review Information and Forms - Click here to link | ||
Fire Safety Survey Report form | PDF File 39KB | |
Annual Occurrence Report form | Word 42KB | PDF File 39KB |
Best Practices Report form | Word 37KB | PDF File 34KB |
CSU Directory | PDF File 23KB | |
Directories for Psychiatric Hospitals Directories are updated on the 1st and 15th business day of each month. Revised date appears on first page of listing. |
Excel File 21KB | Alphabetical 15KB PDF By County 32KB PDF |
Application for CLIA Certification and Overview- CMS Link |
Fee Schedule Information - CMS Link |
Application for Permit - Hospital Narcotic Drug Detoxification Treatment Medication Unit |
Word File 430 KB | PDF File40KB |
Application Questionnaire - Hospital Narcotic Drug Detoxification Treatment Medication Unit |
Word File 433 KB | PDF File 39KB |
Fee Submission Form- Narcotic Treatment Program | Word File 109 KB | PDF File 38KB |
Narcotic Treatment Program List of Clinics | Excel File 29KB By Clinic Name |
Center for Medicare & Medicaid Services - Forms | Link to downloadable forms |
Center for Medicare & Medicaid Services - Overview | Link to general overview |
Special Care Facility License Application | Word File 136KB | PDF File 123KB |
Architectural Review Information and Forms - Click here to link | ||
Directory of Special Care Facilities (Revised date appears on first page of listing) |
PDF File 19KB |
Substance Abuse Facility License Application | Word 555KB | PDF File 53KB |
Substance Abuse Facility License Checklist | Word 34KB | PDF File 64KB |
Substance Abuse Facility ADA Checklist. Click to link. | ||
Substance Abuse Facility Closure Information | Word 32KB | PDF File 63KB |
Court Commitment Application | Word 82KB | PDF File 37KB |
Helpful Phone Numbers | Word 26KB | PDF File 11KB |
Substance Abuse Licensed Sites/By City Order | PDF File 309KB | |
Faith-based Exemption Registration Application | Word 26KB | PDF File 10KB |
Faith-based Registered Exempt Directory Link |
Disclosure and Consent - Medical and Surgical Procedures - English | Word File 26KB | PDF File 53KB |
Disclosure and Consent - Medical and Surgical Procedures - Spanish | Word File 27KB | PDF File 58KB |
Disclosure and Consent - Radiation Therapy - English | Word File 25KB | PDF File 58KB |
Disclosure and Consent - Radiation Therapy - Spanish | Word File 26KB | PDF File 57KB |
Disclosure and Consent - Hysterectomy - English | Word File 33KB | PDF File 75KB |
Disclosure and Consent - Hysterectomy - Spanish | Word File 25KB | PDF File 71KB |
Back to the Top - Health Facility Program Home -- Site Map -- Links - Contact Us
Texas Department of State Health Services, Health Facillity Licensing Program
1100 West 49th Street - Austin, Texas 78756 - (512) 834-6646
Last Updated November 16, 2007
Contact Us | Compact with Texans | Homeland Security | Internet Policy | Site Map | Statewide Search | Texas Online |