TX HHS Form 8614. Grievance Regarding Ombudsman Certification Decision

The TX HHS Form 8614, "Grievance Regarding Ombudsman Certification Decision", is a crucial document for individuals who have been refused certification as a long-term care ombudsman or whose certification has been suspended or terminated. This form serves as a means to express dissatisfaction with the decision and provide supporting evidence.

Key features of this form include required information such as contact details, the reason for submitting a grievance (refusal, suspension, or termination), and a list of reasons for disagreeing with the decision. Additionally, the form allows individuals to identify relevant persons who can provide information relevant to their request. The affirmation section ensures that the submitted information is true and accurate.

This form should be used by individuals seeking to address issues related to ombudsman certification decisions made by the Texas Health and Human Services State Long-Term Care Ombudsman Program. It is essential to note that documentation supporting the grievance can be sent as an attachment to [email protected] or by contacting 512-438-4265 for questions.