TX HHS Form 2700. Application for a Treatment Decision by a Surrogate Consent Committee

The TX HHS Form 2700 is an application for a treatment decision by a Surrogate Consent Committee. This form helps solve the problem of obtaining approval for non-emergency treatments on behalf of individuals with intellectual disabilities or related conditions who are unable to communicate their own preferences.

This form should be used when an Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) representative needs to request a treatment decision from the Surrogate Consent Committee. The application requires information about the individual being treated, including their name, address, and condition or disease. It also asks for details about the proposed treatment, such as the type of treatment, dosages, and names of healthcare professionals involved.

The form has several key features that are important to note. For example, it requires a separate application and certification of need form when submitting multiple treatment applications. The form also allows for the option to check boxes indicating the type of treatment being requested, including major medical treatment, major dental treatment, and highly restrictive procedures. Additionally, the form requires an opinion about the proposed treatment and alternatives from the person or representative submitting the application.