TX HHS Form 0066. Request for Authorized Electronic Monitoring

The Texas Health and Human Services (HHS) Form 0066, Request for Authorized Electronic Monitoring, allows individuals or their authorized representatives to request permission for electronic monitoring in accordance with Chapter 242 and 247 of the Texas Health and Safety Code. This form is designed to provide a standardized process for requesting and conducting authorized electronic monitoring.

This form is intended for use by residents, guardians, or legal representatives who wish to conduct electronic monitoring in facilities regulated by HHS. The form requires the requestor to provide their name and the name of the resident being monitored, as well as information about the type of monitoring device being used. Additionally, the form includes instructions for ensuring the privacy rights of the resident are protected.

The Texas Health and Human Services (HHS) issues this form to facilitate compliance with state regulations regarding electronic monitoring in facilities regulated by HHS. The form is only valid when signed by the resident or their authorized representative, as provided in the Texas Health and Safety Code and Chapter 40 of the Texas Administrative Code.