TX HHS Form 3205. End Stage Renal Disease Facility License Renewal Addendum

The TX HHS Form 3205, End Stage Renal Disease Facility License Renewal Addendum, is a crucial document for healthcare facilities that provide dialysis services to patients. This form helps solve the problem of renewing or updating a facility's license to operate in the state of Texas, ensuring compliance with regulations and maintaining certification.

This addendum requires key information from facilities, including administrator details, personnel credentials, and Medicare certification status. Facilities must also provide evidence of annual fire safety inspections, demonstrating their commitment to patient safety and regulatory compliance. The form's sections include Services, Administrator, Personnel, Medicare Certification, and Fire Survey Reports, each with specific requirements for completion.

The TX HHS Form 3205 should be used by End Stage Renal Disease (ESRD) facilities seeking to renew or update their license in Texas. This includes facilities that provide hemodialysis, peritoneal dialysis, or other forms of renal replacement therapy. By completing this form, facilities can ensure they meet the necessary requirements for licensure and maintain certification with the Centers for Medicare & Medicaid Services (CMS).