TX HHS Form 1573. Residential Review Evidence of Correction

The Texas Health and Human Services (HHS) Form 1573, Residential Review Evidence of Correction, serves as a crucial tool for providers to demonstrate compliance with residential review requirements. This form is designed to collect evidence of correction from providers who have received a Residential Review Report from the Department of Aging and Disability Services (DADS).

The purpose of this form is to provide a standardized mechanism for submitting evidence of correction, which must be submitted within 14 calendar days of receiving the Residential Review Report. The form requires providers to submit documentation, photos, receipts, or other relevant evidence for each checklist item marked "fail" that is not deemed significant risk. Each piece of evidence must be labeled with the corresponding checklist number.

This form is intended for use by residential review providers who have received a Residential Review Report from DADS. The issuing agency, Texas HHS, has approved this form for use in waiver survey and certification processes. Providers can submit their evidence using one of three methods: email, fax, or mail. A copy of the cover sheet must be included with each submission.