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 healthcare providers to document and report incidents that occur in rural hospitals. This form helps ensure prompt reporting of abuse, neglect, or exploitation, as well as other critical events such as fires.

This incident report requires the submission of specific information, including the date and time of the incident, facility details, patient information (if applicable), suspected cause of death, and diagnoses. The report must be completed as soon as possible, but not later than 10 calendar days following the occurrence. Healthcare providers are responsible for reporting incidents to HHSC in a timely manner.

The TX HHS Form 6111 is designed to facilitate prompt reporting and investigation of incidents that affect patient care or well-being. By using this form, healthcare providers can ensure compliance with regulatory requirements and maintain high standards of patient safety. Key features include:

• Required information for incident reporting
• Prompt submission deadlines
• Responsibilities for healthcare providers to report incidents
• Situations where the form is used, such as abuse, neglect, or exploitation