TX HHS Form 3226. Freestanding Emergency Medical Care Facility License Application

The TX HHS Form 3226, Freestanding Emergency Medical Care Facility License Application, is a crucial document for healthcare providers seeking to establish or expand their freestanding emergency medical care facilities in Texas. This form helps solve the problem of obtaining the necessary license to operate such a facility, ensuring compliance with state regulations and providing patients with access to quality emergency care.

The application requires key information about the facility, including its doing business as (DBA) or assumed name, street address, mailing address, area code and phone number, and fax number. Additionally, the form seeks ownership information, such as the legal name of the direct owner responsible for day-to-day operations, whether by lease or ownership. This section also includes space to attach supporting documents, such as a letter assigning an Employer Identification Number (EIN) and an organizational chart showing ownership structure.

This form should be used when applying for a license to operate a freestanding emergency medical care facility in Texas. It is essential to complete the application accurately and thoroughly, providing all required information and supporting documentation to ensure a successful submission. The TX HHS Form 3226, Freestanding Emergency Medical Care Facility License Application, is a critical step in establishing or expanding a healthcare facility in the state of Texas.