TX HHS Form 2803. Critical Incident Report

The TX HHS Form 2803, Critical Incident Report, is a crucial document for reporting critical incidents related to the Youth Empowerment Services (YES) Waiver. This report helps ensure that all known critical incidents are documented and submitted to the YES Waiver Team within 72 hours of being notified.

The form requires specific information about the participant and provider, including the participant's name, date of birth, and date of incident. It also asks for details about the type of incident, such as death, allegation of abuse or neglect, or hospitalization. The report must be completed by a Legally Authorized Representative (LAR) or the YES Provider Organization.

The TX HHS Form 2803 is used to document critical incidents that occur in the context of the YES Waiver services. Key features include the requirement to submit the form within 72 hours, the need to select only the most relevant incident type from a drop-down menu, and the obligation to provide detailed descriptions for each selected incident type. By completing this report, providers can help ensure compliance with the Critical Incident Reporting Policy 3200 and maintain accurate records of incidents.

• The form must be completed and submitted within 72 hours of being notified of the incident.
• Only one primary incident type should be selected from a drop-down menu.
• Detailed descriptions are required for each selected incident type.