TX HHS Form 2749. Submitting an Application Packet for a Treatment Decision

The TX HHS Form 2749, "Submitting an Application Packet for a Treatment Decision", is used to request treatment decisions from a Consent Committee. This form helps solve the problem of obtaining approval for various treatments, including major medical treatment, major dental treatment, psychoactive medication, and highly restrictive procedures.

To submit an application packet, you must include original copies of required forms, such as Form 2700 (Application for a Treatment Decision by a Surrogate), Form 2725 (List of Persons to Receive Notification of Surrogate), and Form 2750 (Surrogate Decision Making Program Data). You may also need to provide certifications of need, depending on the type of treatment decision being requested. Additionally, you must submit required documentation, including lab work, pharmacy reviews, and EKG and chest x-ray results.

This form is typically used when a surrogate decision maker is needed to make treatment decisions for an individual. The application packet should include a written statement from the prescribing physician justifying the need for psychoactive medication or highly restrictive procedure, as well as a cumulative psychoactive medication history and social history. Other required documentation includes a copy of the behavior program/goal and objective/service plan, monthly frequency count of target behaviors, and copies of psychiatric consultations.