TX HHS Form 3650. Assisted Living Facility Memory Care Disclosure Statement

The TX HHS Form 3650, Assisted Living Facility Memory Care Disclosure Statement, is a crucial document for assisted living facilities that provide memory care services to residents. This form helps solve the problem of ensuring transparency and compliance with regulations regarding the provision of memory care services.

This disclosure statement requires facilities to indicate which services they offer, including assistance in transferring to and from a wheelchair, bladder and bowel incontinence care, medication injections, and more. Facilities must also complete sections on the pre-admission process, which may involve facility tours, family interviews, medical records assessments, and applications.

The form is intended for assisted living facilities that advertise, market, or promote memory care services to residents. It should be completed according to the care and services provided by the facility. The statement must be signed and dated, and a copy must be provided to anyone who requests information about memory care services. The form also requires facilities to post the disclosure statement along with their facility license.