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

The TX HHS Form 3226 is a crucial document for freestanding emergency medical care facilities seeking licensure in Texas. This application helps solve the problem of ensuring that these facilities meet specific standards and requirements to provide high-quality patient care. The form is typically used by facility owners or operators who need to obtain a license to operate their emergency medical care facility.

The Form 3226 requires key information, including the facility's doing business as (DBA) name, street address, mailing address, area code and phone number, and fax number. Additionally, the form asks for ownership information, such as the legal name of the direct owner responsible for day-to-day operations, along with their Employer Identification Number (EIN). The applicant must also provide a copy of the EIN letter from the IRS, a Certificate of Filing from the Office of the Secretary of State, and an Organizational Chart showing ownership structure.

Key features of this form include the requirement to provide projected dates for facility opening, as well as current license numbers and architectural project numbers. The applicant must also indicate whether they are a sole proprietor or not, and provide their Social Security Number (SSN) if applicable. By completing this application, freestanding emergency medical care facilities can demonstrate compliance with Texas Health and Human Services' regulations and obtain the necessary licensure to operate.

• The Form 3226 is used by facility owners or operators seeking licensure for their freestanding emergency medical care facilities in Texas.
• The application requires key information, including facility name, address, phone number, and ownership details.
• The applicant must provide supporting documentation, such as EIN letters and Organizational Charts.