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

The TX HHS Form 3026 is a crucial document for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICFs/IID) to submit in response to a random sample review. This form helps ensure that ICFs/IID facilities maintain accurate records of their nursing staff and provide necessary documentation for the health and well-being of individuals under their care.

The form requires ICFs/IID facilities to submit specific information, including the most recent quarterly nursing or annual physician physical exam report, as well as a list of registered nurses' and licensed vocational nurses' names, titles, and signatures. Facilities must also indicate whether they have submitted any additional documents requested by HHS after the initial review.

To facilitate compliance with this requirement, ICFs/IID facilities should submit the form to HHS within five business days of receipt. Failure to do so may result in further requests for information or other follow-up actions. Key points to note include:

• The form is used for random sample reviews by HHS.
• ICFs/IID facilities must submit the form within five business days.
• The form requires submission of specific documentation, including nursing or physician exam reports and nurse signatures.