Neonatal Facility Designation Application Level I
This file contains the application for Level I Neonatal Facility Designation by the Texas Department of State Health Services. It provides detailed instructions for applicants on submission processes, required documents, and important contact information. The application is essential for healthcare facilities seeking designation as neonatal facilities in Texas.
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How do I fill this out?
To fill out the application, you will first need to download the file and save it on your computer. Open it using Adobe software to complete the required information electronically. Ensure you provide accurate details and follow the guidelines for submission to avoid any delays in processing.
How to fill out the Neonatal Facility Designation Application Level I?
1
Download and save the application file.
2
Open the file using Adobe software.
3
Complete all required sections of the application.
4
E-sign the document and save it.
5
Email the completed application along with supporting documents to the designation team.
Who needs the Neonatal Facility Designation Application Level I?
1
Healthcare facilities aiming for Level I neonatal designation.
2
Administrators of healthcare organizations looking to comply with state regulations.
3
Medical directors who oversee neonatal care services.
4
Quality assurance teams responsible for maintaining healthcare standards.
5
Financial officers managing application fees and associated costs.
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What are the instructions for submitting this form?
To submit your application, email the completed form along with the required supporting documents to dshs.ems-trauma@dshs.texas.gov. Make sure to include the subject line 'Neonatal Application Packet: [Facility Name and PCR]'. For additional queries, contact the Designation Program Specialists listed earlier.
What are the important dates for this form in 2024 and 2025?
The application must be submitted within 90 days of completing the Self-Survey Report and Attestation Letter. Renewal applications should also be submitted no later than 90 days prior to the expiration date. Notable revision dates include January 2024.
What is the purpose of this form?
The purpose of this form is to enable healthcare facilities in Texas to apply for Level I neonatal designation. This designation signifies the facility's capability to provide specialized care for newborns and premature infants. Completing this application is essential for organizations aspiring to meet state health standards and improve service offerings in neonatal care.
Tell me about this form and its components and fields line-by-line.
- 1. Facility Name: The official name of the healthcare facility.
- 2. Physical Street Address: The complete address of the facility.
- 3. City: The city where the facility is located.
- 4. Zip Code: The postal code for the facility's location.
- 5. License Number: A unique 6-digit number assigned by DSHS.
- 6. Application Fee: The required fee based on the facility's licensed bed count.
What happens if I fail to submit this form?
Failing to submit this form may result in delays or refusal of neonatal designation. It is crucial to adhere to submission deadlines to ensure a smooth application process. Late submissions could necessitate reapplication and additional costs.
- Application Processing Delays: Incomplete submissions can lead to extended processing times.
- Loss of Designation Opportunities: Failure to apply within the required timeframe may preclude receiving necessary designations.
- Potential Compliance Issues: Facilities may need to address compliance concerns if the application is not submitted.
How do I know when to use this form?
- 1. Initial Designation: For facilities that have not previously been designated.
- 2. Change of Ownership: When there's a change in the facility's ownership.
- 3. Level Change: If a facility wishes to change its designation level.
Frequently Asked Questions
How do I edit this PDF?
You can edit the PDF by opening it in PrintFriendly's editor and using our intuitive editing tools.
Can I save my changes?
You can download your edited document after making changes.
Is there a fee for submitting this form?
There is an application fee based on the number of licensed beds in your facility.
Who can I contact for questions about the application?
You can contact the Designation Program Specialists listed in the document.
How do I submit the application?
Email the completed application and required documents to the designated email address.
What is the processing time for this application?
Processing times can vary, but the designation team will respond as quickly as possible.
Are there instructions for e-signing the application?
Yes, instructions for e-signing are available within the application itself.
What if my application is denied?
You will receive notification detailing the reasons for denial and instructions for reapplying.
Can I edit the application after submitting?
Once submitted, you will need to contact the designation team for any changes.
What is the deadline for submitting the application?
The application must be submitted within 90 days of completing the self-survey report.
