TX HHS Form 1125. Resident's Request to Remain in Facility

The Texas Health and Human Services (HHS) issues Form 1125, Resident's Request to Remain in Facility, for situations where an assisted living facility or HHS determines that a resident is inappropriately placed. This form serves as a request mechanism for the resident or their family member to express their desire to continue residing in the facility.

The purpose of this form is to provide a means for residents who lack capacity to make decisions about their placement, or those who are physically unable to sign documents themselves, to communicate their wishes. The form must be completed by the resident or their authorized representative and submitted to the relevant Regional Office of Regulatory Services along with supporting documentation.

This form is an essential tool for ensuring that residents' rights are respected and their needs are met. By providing a clear mechanism for requesting continued residence in an assisted living facility, Form 1125 promotes transparency and accountability within the Texas HHS system.