TX HHS Form 3206. Chemical Dependency Treatment Facility Closure

The TX HHS Form 3206, Chemical Dependency Treatment Facility Closure, is a crucial document used to notify Texas Health and Human Services (HHS) of the closure of a chemical dependency treatment facility. This form helps facilities comply with regulatory requirements and ensures a smooth transition for clients.

This form requires key information about the facility, including its name, headquarters address, license number, and effective date of closure. It also asks whether the facility is closing its headquarters or a licensed site, and if applicable, provides space to list the site license number. The CEO, Clinical Program Director, or Facility Contact must sign and attest that the facility has completed certain steps before closure, such as returning licensure certificates, making client transfers and referrals, and arranging for confidential record storage.

The form is typically used when a chemical dependency treatment facility decides to cease operations. It should be completed and submitted to HHS in accordance with Texas Administrative Code Title 26 (26 TAC) Section 564.508(h), which requires facilities to retain client records for six years after closure. By using this form, facilities can ensure compliance with regulatory requirements and maintain a professional reputation.