TX HHS Form 1123. Review of Assisted Living Facility Type C

The Texas Health and Human Services (HHS) Form 1123 is a review form for Assisted Living Facility Type C providers. This document serves as a tool for HHS to assess the qualifications and compliance of facilities providing assisted living services to adults in need of care.

The purpose of this form is to ensure that facilities meet specific requirements, including provider qualifications, tuberculosis examination, and employee screening through the Employee Misconduct Registry (EMR) and Nurse Aide Registry (NAR). The form also verifies that facilities comply with relevant state laws and regulations, such as Chapter 250 of the Health and Safety Code.

This review form is intended for use by Assisted Living Facility Type C providers in Texas. It is essential for these facilities to complete this form accurately and thoroughly to demonstrate their commitment to providing high-quality care and services to adults in need. By completing Form 1123, facilities can ensure compliance with HHS regulations and maintain a safe and healthy environment for residents.