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), is a crucial tool for evaluating the compliance of emergency response services providers. This form helps ensure that providers initiate services within the required timeframe, maintain accurate documentation, and provide proper orientation to responders.

The key features of this form include the requirement for providers to document the reason for any delay in service initiation and describe their efforts to initiate services. The form also assesses whether providers installed and tested emergency response equipment during initial home visits and explained its use to individuals. Standard 2 evaluates compliance with these requirements, while Standard 3 focuses on responder orientation.

This form should be used when evaluating the compliance of emergency response services providers, particularly in situations where new responders are being trained or existing ones need re-orientation. The form's practical application is to ensure that providers meet the necessary standards for service initiation and responder training, as outlined in Texas Administrative Code (TAC) §279.71, Referrals, and other relevant sections.