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 and tracking incidents that occur in ambulatory surgical centers (ASCs) in Texas. This form helps ensure that ASCs promptly report and document incidents, such as patient injuries or deaths, theft of drugs, or diversion of controlled substances.

The form requires specific information to be reported within certain timeframes, including the date and time of the incident, facility details, and patient information if applicable. Key features include reporting requirements for fires that cause injury to a person, surgical fires, patient deaths, transfers to hospitals, theft or diversion of drugs, and prolonged patient stays. The form also emphasizes the importance of prompt reporting, with specified deadlines for submitting reports.

By using this form, ASCs can demonstrate their commitment to patient safety and regulatory compliance. Key points to note include:

• Reporting incidents within specific timeframes
• Providing detailed information about the incident, including facility details and patient information if applicable
• Complying with reporting requirements for various types of incidents