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 facilitate the renewal process of an existing license by providing essential information about the facility's personnel.

This addendum requires the submission of detailed information about all licensed professionals who provide services at the abortion facility. Specifically, it asks for names, Texas Provider Identification numbers (if Medicaid-enrolled), National Provider Identification numbers, and license numbers with expiration dates. The form also includes a section for administrators to submit their own contact information.

The TX HHS Form 3201 should be used by licensed abortion facilities in Texas when renewing their facility licenses. This process typically involves submitting the required personnel information, as well as a copy of the organizational structure of all staff for the facility. By completing this form, facilities can ensure compliance with state regulations and maintain their licensure.