TX HHS Form 2750. Surrogate Decision Making Program Data Form

The TX HHS Form 2750, Surrogate Decision Making Program Data Form, is a crucial tool for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) Representatives. This form helps solve the problem of ensuring that surrogate decision-making arrangements are in place for individuals who lack the capacity to make their own medical decisions. The form is typically used in situations where an individual's healthcare provider needs to determine a surrogate decision maker, and it provides a standardized way to collect essential information.

The form requires specific information from the ICF/IID Representative, including demographic details, method of communication, and number of living and known relatives. It also asks about the method of communication used by the individual, which can be verbal, gestural, or through the use of a communication device. The form emphasizes the importance of indicating "NA" if information is not applicable, ensuring that all necessary data is collected.

This form is essential for healthcare providers and ICF/IID Representatives to ensure that surrogate decision-making arrangements are in place. By completing this form, representatives can provide critical information about an individual's communication methods and relationships, which helps healthcare providers make informed decisions about their care. Key points to note include:

• The form is used by ICF/IID Representatives to determine a surrogate decision maker.
• The form requires demographic information, method of communication, and number of living and known relatives.
• The form emphasizes the importance of indicating "NA" if information is not applicable.