TX HHS Form 3762. Room Size Variance

The TX HHS Form 3762, "Room Size Variance", is a crucial document used to request a waiver from the standard room size requirements for facilities. This form helps solve the problem of non-compliance with minimum square footage per resident in multiple or single resident rooms.

This form requires specific information, including the facility name, vendor number, type of facility, exit date, and address. The form also outlines four justification criteria that must be met to approve a waiver: the minimum square footage allowed for a waiver, sufficient space for ambulatory residents or those with physical disabilities, no adverse impact on resident health and safety, and no impediment to achieving the highest practicable well-being.

The Room Size Variance form should be used when a facility seeks to deviate from the standard room size requirements. The form must be reviewed and considered for renewal during each standard survey, as per Federal Requirement 438.70(d)(I)(ii) and Licensure Medicaid Requirement 19.1701(4)(A)(ii).