TX HHS Form 6110. Ambulatory Surgical Center Facility Incident Report

The TX HHS Form 6110, Ambulatory Surgical Center Facility Incident Report, is a crucial tool for reporting incidents that occur in ambulatory surgical centers (ASCs). This form helps ASCs document and report various types of incidents, including injuries, fires, patient deaths, theft or diversion of controlled drugs, prolonged patient stays, and complications resulting in hospital admission.

The form requires specific information to be reported, such as the date, time, and facility details. It also includes sections for reporting patient information, if applicable. The reportable incidents include fires causing injury to a person, surgical fires when using flammable germicides, patient deaths while under ASC care, theft or diversion of controlled drugs, prolonged patient stays exceeding 23 hours, and complications resulting in hospital admission.

This form should be used by ASCs to report incidents not later than the next business day for certain types of incidents, such as fires causing injury or patient death. For other incidents, reports must be submitted within a specified timeframe, which varies depending on the type of incident. The TX HHS Form 6110 is an essential tool for ensuring timely and accurate reporting of incidents in ASCs.