The Texas Department of Aging and Disability Services (DADS) has revised Form 3613-A, SNF, NF, ICF/IID, ALF, ADC, DAHS, and PPECC Provider Investigation Report with Fax Cover Sheet. The form now lists both an email address and facsimile number for form submission. It also includes PPECC as one of the license types required to use Form 3613-A when reporting an incident. SNF, NF, ICF/IID, ALF, ADC and PPECC providers must report incidents as follows: ? Report incidents to Consumer Rights and Services by calling 1-800-458-9858 or online at https://www.dads.state.tx.us/services/crs/incidentforms/SRI/index.cfm.
Then, submit a completed Form 3613-A, with statements and other relevant documentation, per the following time frames: o ALF, ADC and PPECC providers must submit Form 3613-A within five calendar days after making the oral report. o SNF, NF and ICF/IID providers must submit Form 3613-A within five working days after making the oral report. If Form 3613-A, including statements and other relevant documentation, is 15 pages or less, email it to crsprovider@dads.state.tx.us or fax it toll-free to DADS at 1-877-438-5827.
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