TX HHS Form 3711. Request for Bed Changes and Bed Relocations

The TX HHS Form 3711, Request for Bed Changes and Bed Relocations, is a crucial document that helps long-term care facilities request changes to their bed configurations. This form is typically used by facility administrators who need to adjust the number of beds or relocate them within the facility.

To ensure the request is processed, all required information must be submitted with the form. This includes the current and proposed floor plans, a list of room numbers and bed counts, and the signature and date of the authorized representative. The form also specifies that incomplete requests will not be considered complete, emphasizing the importance of thoroughness in submitting the request.

Key features of this form include the requirement to provide detailed information about the current and proposed bed configurations, as well as the need for a signature and date from the authorized representative. Facilities should submit their requests to the Texas Health and Human Services Commission or its Regulatory Services department. For related questions or concerns, facilities can contact Medicaid Bed Allocation at 512-438-2630 or by email at [email protected].

• Used for requesting changes to bed configurations in long-term care facilities
• Requires current and proposed floor plans, room numbers, and bed counts
• Incomplete requests will not be processed
• Submit requests to Texas Health and Human Services Commission or its Regulatory Services department