TX HHS Form 3201. Abortion Facility License Renewal Addendum

The TX HHS Form 3201 Abortion Facility License Renewal Addendum is a crucial document for licensed abortion facilities in Texas. This form helps ensure compliance with state regulations by providing an update on the facility's personnel, including their names, provider identification numbers, and license information.

This addendum requires the submission of detailed information about all licensed professionals who provide services at the facility, including their Texas Provider Identification numbers (if Medicaid-enrolled) and National Provider Identification numbers. The form also asks for the administrator's contact information and a copy of the organizational structure of all staff for the facility.

The TX HHS Form 3201 Abortion Facility License Renewal Addendum is typically used by licensed abortion facilities in Texas to renew their licenses and demonstrate compliance with state regulations. This form helps ensure that these facilities are providing safe and high-quality services to patients, while also promoting transparency and accountability.

• This form is required for all licensed abortion facilities in Texas seeking to renew their licenses.
• The form requires detailed information about facility personnel, including provider identification numbers and license information.
• The administrator's contact information must be provided, along with a copy of the facility's organizational structure.