TX HHS Form 3212. Birthing Center License Application

The TX HHS Form 3212, Birthing Center License Application, is a crucial document for birthing centers seeking to operate in the state of Texas. This form helps solve the problem of ensuring that birthing centers meet the necessary standards and requirements for licensure, thereby protecting the health and well-being of mothers and newborns.

The application requires key information about the facility, including its doing business as (DBA) name, mailing address, phone number, and fax number. Additionally, the form asks for ownership information, such as the legal name and employer identification number (EIN), as well as a copy of the IRS letter assigning the EIN or Certificate of Filing from the Office of the Secretary of State. The form also inquires about the ownership structure of all staff at the facility.

Key features of this form include the requirement for a sole proprietor, partnership, corporation, or management contract to complete Section 3, which asks if the birthing center is owned by one of these entities. The form also includes instructions for completing the Ownership Addendum in Section 7. By filling out this application, birthing centers can ensure compliance with Texas Health and Human Services (HHS) regulations and obtain the necessary licensure to operate.

• This form is used by birthing centers seeking licensure from the state of Texas.
• The application requires key information about the facility's ownership structure, staff, and operations.
• Completion of this form helps ensure compliance with Texas HHS regulations and obtains necessary licensure for operation.