TX HHS Form 3613. Provider Investigation Report with Fax Cover Sheet (Home Health. Hospice and Personal Assistance Services Provider Use Only)

TX HHS Form 3613, Provider Investigation Report with Fax Cover Sheet, is a document used by Home Health, Hospice, and Personal Assistance Services providers to report complaints and incidents related to their services. This form helps solve the problem of documenting and reporting issues that may impact the quality of care provided to patients.

The fax cover sheet provides required information such as date, recipient's email address, and contact details. The Provider Investigation Report section requires the provider to provide details about the incident or complaint, including the date, location, and description of what happened. This form should be used when a provider needs to report an issue that has occurred during the provision of their services.

This confidential document contains privileged or confidential information and is intended for use by authorized personnel only. The form must be completed accurately and thoroughly, as it serves as a record of the investigation and incident reporting process. By using TX HHS Form 3613, providers can ensure compliance with regulatory requirements and maintain transparency in their operations.