TX HHS Form 6101. Birthing Center Facility Incident Report

The TX HHS Form 6101, Birthing Center Facility Incident Report, is a crucial document that helps ensure the timely reporting of incidents occurring in birthing centers. This form is used to report situations where a mother or newborn remains at the center for medical reasons beyond 24 hours after birth, as well as deaths of patients, newborns, or fetuses during labor or within 24 hours of discharge.

The form requires specific information, including the date and time of incident, facility license number, and reporter's name. It also asks for patient information, such as first, middle, and last names, date of birth, gestation, gravida, parity, and diagnoses. The report must be filed within 48 hours of the incident or death, with a follow-up report submitted five calendar days after the occurrence.

Key features of this form include the requirement to report incidents involving extended stays or deaths, as well as the need for timely reporting. By using this form, birthing centers can ensure compliance with regulations and provide critical information for quality improvement and patient safety initiatives. Some key points to note include:

• Reportable incidents include extended stays beyond 24 hours after birth or deaths during labor or within 24 hours of discharge.
• The form must be filed within 48 hours of the incident or death, with a follow-up report submitted five calendar days later.
• Patient information is required for incidents involving patients, including diagnoses and dates of admission and discharge.