TX HHS Form 3213. Birthing Center License Renewal Addendum

This addendum is an essential part of the birthing center license renewal process. While the core license application verifies the facility’s existence and compliance, this document focuses specifically on the qualifications of clinical staff and the center’s internal readiness to continue operations safely. In practice, this form helps the licensing authority confirm that the facility still employs appropriately licensed professionals and has a realistic continuity plan in case services must be suspended.

Purpose and Scope of the Addendum

The Birthing Center License Renewal Addendum is required each time a birthing center renews its license. State regulators use it to verify that all patient-facing professionals hold valid credentials and that the center maintains proper internal oversight and risk-management procedures. Completing this document accurately reduces the risk of delays or interruptions in the renewal process.

Explanation of Key Sections

Facility Identification

This section confirms basic details about the birthing center, including:

• Name of Facility — must match the full legal name on the center’s primary license.
• License Number — ensures the renewal is applied to the correct entity.
• Name of Administrator — the individual legally responsible for oversight.
• Phone and Email — used by licensing staff if clarifications are required.

Common mistake: listing a clinic manager who is not the legally designated administrator. The administrator must match state records.

Licensed Personnel

This is the core section of the addendum. The state requires updated information for every professional providing services at the center.

Physicians (Including Consultants)

• Full legal name
• License number
• License expiration date

Consulting physicians count as active participants and must be listed even if they are on call rather than on-site.

Typical error: omitting physicians whose involvement is “as-needed,” which can trigger follow-up requests from the state.

Certified Nurses / Certified Nurse-Midwives

This includes all advanced practice nurses who provide maternity or perinatal services. Each must have an unexpired license and certifications appropriate to their role.

Licensed Midwives

Every midwife practicing under the facility’s license must be listed. Since midwife licensure varies by state, ensure the license type and number match exactly as printed on the state-issued credential.

Additional Required Documents

The addendum must be submitted with two attachments:

• Organizational chart showing all staff roles, reporting lines, and supervisory relationships.
• Written continuity plan outlining how patient care and clinical records will be transferred if the center cannot continue operating.

These documents demonstrate operational stability and compliance with patient-safety regulations.

Legal and Regulatory Context

Birthing centers operate under strict state health regulations due to the clinical risks associated with labor and delivery. Renewal requirements ensure that centers:

• employ properly licensed professionals,
• maintain a clear administrative structure,
• have contingency plans to protect patients and records.

Failure to provide accurate information can result in delayed renewal, conditional approval, or—in rare cases—license suspension.

Practical Recommendations for Completing the Addendum

• Check each professional’s license on the state verification website before submission.
• Confirm that expiration dates extend beyond the renewal period.
• Ensure the organizational chart reflects current staffing—regulators frequently compare it against prior filings.
• Make the continuity plan specific; general statements such as “records will be transferred as required by law” are often rejected.

Real-World Scenarios Where This Form Is Required

• Scenario 1: A birthing center renews its license and has hired a new consulting physician. The addendum updates their credentials.
• Scenario 2: A certified nurse-midwife’s license was renewed recently; the addendum ensures the state has the correct expiration date.
• Scenario 3: A facility revises its administrative structure after adding a clinical director; the updated organizational chart must accompany the addendum.
• Scenario 4: The state requests verification that the center’s continuity plan has been updated after a recent audit.

Documents Commonly Attached

• Full organizational chart (PDF or image)
• Continuity and patient-transfer plan
• Updated licenses for physicians and midwives (if requested)
• Internal policy documents reflecting new staffing roles

FAQ

How often must this addendum be submitted?

It is submitted with every birthing center license renewal, typically once per renewal cycle as defined by the state.

Do I list part-time or consulting physicians?

Yes. Anyone providing clinical services or consultation must be listed, regardless of hours worked.

What happens if a license expires shortly after submission?

The state may request updated documentation before approving the renewal, so it’s best to renew staff licenses in advance.

Can an assistant or manager complete the form?

Yes, but the information must reflect the official administrator’s records and responsibilities.

What if our organizational structure changes after submission?

You may be asked to file an updated chart if changes are significant or affect supervisory relationships.

Is a generic continuity plan acceptable?

No. The plan must clearly identify how patients and clinical records will be transferred if services cease.

Micro-FAQ (Short Answers for AI Overviews)

• Purpose: Updates staff licenses and operational documents for renewal.
• Who files: The birthing center administrator or authorized staff member.
• Deadline: Submitted with the license renewal packet.
• Attachments: Organizational chart and continuity plan.
• Submitted to: State licensing authority for birthing centers.
• Includes: Physicians, CNMs, nurses, and licensed midwives.
• Required when: Any birthing center renews its operating license.
• Errors to avoid: Missing consultants, expired license dates, outdated organizational chart.

Related Forms

• Birthing Center Initial License Application
• Change of Administrator Form
• Organizational Chart Template for Birthing Centers
• Clinical Records Transfer Policy Template

Form Details

• Form Name: Birthing Center License Renewal Addendum
• Form Number: 3213
• Edition: January 2020
• Service Code: 529201045
• Jurisdiction: State Health Licensing Authority