TX HHS Form 8625-D. Designation of a Long-Term Care Ombudsman as Representative and Request to Appeal a Nursing Facility Discharge

TX HHS Form 8625-D, "Designation of a Long-Term Care Ombudsman as Representative and Request to Appeal a Nursing Facility Discharge," is a crucial document for residents in nursing facilities who wish to appeal a decision to discharge them. This form authorizes a long-term care ombudsman to represent the resident in the appeal process, ensuring that their rights are protected.

The form requires the resident's information, including name, address, and social security number, as well as the facility's information, such as name and address. The resident must also designate the long-term care ombudsman they wish to represent them, providing their contact information, including phone number, email address, and physical address.

This form should be used when a nursing facility decides to discharge a resident, and the resident wishes to appeal that decision. The ombudsman must submit this form by emailing or faxing it to the Texas Health and Human Services Commission (HHSC), along with supporting documentation, such as a copy of the discharge notice and any requests for accommodations at the hearing.