TX HHS Form 3210. Ambulatory Surgical Center License Application

The TX HHS Form 3210, Ambulatory Surgical Center License Application, is a crucial document for healthcare facilities seeking to obtain a license to operate as an ambulatory surgical center in Texas. This form helps solve the problem of ensuring that these facilities meet the necessary requirements and standards for providing safe and quality patient care.

The application requires key information about the facility, including its doing business as (DBA) or assumed name, mailing address, city, state, and ZIP code, as well as area code and phone number. Additionally, the form asks for ownership information, such as legal name, employer identification number (EIN), and type of legal entity. It also requests documentation, including a letter assigning the EIN, certificate of filing from the Office of the Secretary of State, and ownership structure.

This form is typically used by ambulatory surgical centers seeking initial licensure or changes to their existing license. Key features include required information about the facility's ownership structure and contact details. By completing this application, facilities demonstrate their commitment to meeting Texas Health and Human Services (HHS) standards for patient care and safety.

• The form is used by ambulatory surgical centers seeking initial licensure or changes to their existing license.
• It requires key information about the facility's ownership structure and contact details.
• The application asks for documentation, including a letter assigning the EIN and certificate of filing from the Office of the Secretary of State.