TX HHS Form 3264. General and Special Hospital Multiple Location License Renewal Application

The TX HHS Form 3264, General and Special Hospital Multiple Location License Renewal Application, is a crucial document for hospitals seeking to renew their licenses in Texas. This form helps solve the problem of ensuring that hospitals meet state regulations and standards for providing various medical services.

This application requires hospitals to provide detailed information about their services, including medical specialties such as surgery, obstetrical care, clinical laboratory services, and emergency department treatment. Hospitals must also indicate whether they offer specific services like pediatric care, comprehensive medical rehabilitation, or mental health services. Additionally, the form asks questions about end-stage renal disease (ESRD) acute services, including patient populations served and peritoneal dialysis availability.

Key features of this form include required information on hospital services, patient populations, and ESRD stations. The application also inquires about state waivers of hospital regulations. By completing this form, hospitals demonstrate their compliance with Texas Health and Human Services (HHS) regulations and standards for providing medical services.

• This form is used by hospitals seeking to renew their licenses in Texas.
• It requires detailed information on hospital services, patient populations, and ESRD stations.
• The application asks about state waivers of hospital regulations.