TX HHS Form 3249. Hospital Waiver Request

The TX HHS Form 3249, Hospital Waiver Request, is a crucial document that helps hospitals request waivers or modifications to specific provisions of the Texas Health and Safety Code Chapter 241, the Texas Hospital Licensing Law. This form is typically used by hospital administrators or designees who need to request exemptions from certain physical plant or construction requirements.

The form requires key information about the hospital, including its name, physical street address, license number, and whether it is licensed under a multiple-location hospital license. Additionally, the applicant must provide contact information for the administrator or designee, as well as professional design firm details if applicable. The form also outlines the specific waiver request process in accordance with Texas Health and Safety Code Section 241.026(c) and Texas Administrative Code Title 25 (25 TAC) Section 133.81.

Key features of this form include the requirement to complete Form 3250, Hospital Statute and Rule Waiver Request Application for Facility Physical Plant and Construction Requirements, if seeking a waiver for physical plant and construction requirements. The form also highlights specific sections that may be waived or modified, including those related to domestic water distribution systems, soiled workrooms, and more. By using this form, hospitals can streamline their waiver request process and ensure compliance with relevant regulations.

• The TX HHS Form 3249 is used by hospital administrators or designees to request waivers or modifications to specific provisions of the Texas Health and Safety Code Chapter 241.
• The form requires key information about the hospital, including its name, physical street address, license number, and contact information for the administrator or designee.
• The form outlines the specific waiver request process in accordance with relevant state codes and regulations.