TX HHS Form 2803. Critical Incident Report

The TX HHS Form 2803, Critical Incident Report, is a crucial tool for reporting critical incidents that occur in youth empowerment services (YES) waiver programs. This form helps ensure timely and accurate reporting of incidents, which is essential for maintaining program integrity and ensuring participant safety.

This report must be completed and submitted to the YES Waiver Team within 72 hours of being notified of the incident. The form requires participants and providers to provide essential information, including participant name, date of birth, and date of incident. Section B allows users to select the most relevant type of incident from a dropdown menu, with options including death, allegation, arrest/criminal activity, and more.

The form is designed for use in various scenarios, such as reporting incidents involving participant departure, injury/medical emergency, or behavioral/psychiatric emergency. Users must complete Section C to provide detailed descriptions of the incident, including any applicable secondary incidents. The report should be submitted with any questions and completed forms sent to [email protected].