TX HHS Form 6107. Psychiatric Hospital Incident Report

The TX HHS Form 6107, Psychiatric Hospital Incident Report, is a crucial tool for reporting and documenting incidents that occur in psychiatric hospitals. This form helps healthcare professionals and facilities comply with regulations and maintain transparency by recording details of reportable incidents.

This form requires specific information to be reported, including the type of incident (such as abuse, neglect, or unprofessional conduct), date and time of the incident, facility name, license number, and provider number. The form also collects patient-related data, such as name, date of birth, admission and discharge dates, and medical diagnoses.

The Psychiatric Hospital Incident Report should be used whenever an incident occurs in a psychiatric hospital that meets the reporting criteria outlined on the form. This includes incidents related to abuse, neglect, or unprofessional conduct, as well as EMTALA violations. By completing this form, facilities can ensure timely and accurate reporting of incidents, which is essential for maintaining patient safety and regulatory compliance.