TX HHS Form 3026. Random Sample Review of Nursing On-call and/or Deceased Individual Required Submission of Documentation

The TX HHS Form 3026, "Random Sample Review of Nursing On-call and/or Deceased Individual Required Submission of Documentation", is a crucial tool for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICFs/IID) to ensure compliance with regulatory requirements. This form helps ICFs/IID providers submit necessary documentation to Texas Health and Human Services (HHS) within five business days after receipt.

The form requires submission of specific information, including the most recent quarterly nursing or annual physician physical exam (whichever is more current), as well as a list of registered nurses' and licensed vocational nurses' names, titles, and signatures. This documentation helps HHS conduct random sample reviews to ensure the health and well-being of individuals receiving care at ICFs/IID facilities.

This form should be used by ICFs/IID providers when requested by HHS as part of a random sample review. The submission deadline is five business days after receipt of the form, and additional documents may be requested after the initial review. By submitting this documentation in a timely manner, ICFs/IID providers can demonstrate their commitment to providing high-quality care and services to individuals with intellectual disabilities or related conditions.