TX HHS Form 3854. Contract or Program Compliance Individual Record Evaluation (Emergency Response Services)

The TX HHS Form 3854, Contract or Program Compliance - Individual Record Evaluation (Emergency Response Services), helps solve the problem of ensuring compliance with emergency response services contracts or programs. This form is used in situations where individual record evaluations are necessary to verify compliance with specific standards and regulations. Typically, this form is filled out by healthcare professionals and administrators working with Texas Health and Human Services (HHS) to evaluate the performance of emergency response service providers.

The key features of this form include required information such as dates of review periods, initiation of services, and responder orientation. The form also outlines specific conditions and responsibilities for providers, including documentation of service initiation and responder training. Additionally, the form includes follow-up actions and procedures to ensure compliance with regulations and standards.

Some key points and requirements highlighted in this form include:

• The provider must initiate services within a required time frame (14 days after referral date or contractor authorization).
• The provider must maintain documentation of service initiation information in the individual's file.
• The responder must be oriented and trained on emergency response equipment and procedures.