TX HHS Form 6111. Limited Services Rural Hospitals Incident Report

The TX HHS Form 6111, Limited Services Rural Hospitals Incident Report, is a crucial tool for reporting incidents that occur in rural hospitals. This form helps healthcare providers document and report various types of incidents, including abuse, neglect, or exploitation of patients, as well as unprofessional or unethical conduct.

This form requires the submission of specific information, such as the date and time of the incident, facility license number, patient information (if applicable), suspected cause of death, diagnoses, and discharge disposition. The report must be completed as soon as possible, but not later than 10 calendar days following the occurrence.

The TX HHS Form 6111 is designed for use in rural hospitals that provide limited services. It is essential to complete this form accurately and thoroughly to ensure compliance with reporting requirements. This form should be used whenever an incident occurs that meets the reportable criteria, such as abuse or neglect of a patient, or unprofessional conduct.