TX HHS Form 3219. Multiple Location Psychiatric Hospital License Renewal Application

The TX HHS Form 3219, Multiple Location Psychiatric Hospital License Renewal Application, is a crucial document for psychiatric hospitals seeking to renew their license. This form helps solve the problem of ensuring that psychiatric hospitals meet the necessary requirements for continued licensure.

This application requires hospital information, including the name and license number of the main hospital, as well as details about multiple location hospitals within the same facility. The form also asks for information on hospital services and beds, including private psychiatric hospital services, emergency treatment rooms, and licensed bed counts. Additionally, the application requests a description of major medical equipment and facilities used by the hospital, as well as a plan or campus map of the premises.

The form emphasizes the importance of fire safety surveys, requiring a copy of a fire inspection report conducted within the last 12 months, indicating approval by the local fire authority. This ensures that psychiatric hospitals meet annual fire safety inspection requirements for continued licensure status. The TX HHS Form 3219 is essential for psychiatric hospitals seeking to renew their license and maintain compliance with Texas regulations.