Form Title
0066 Request for Authorized Electronic Monitoring
0067 Consent by Roommate for Authorized Electronic Monitoring
1123 Review of Assisted Living Facility Type C
1124 Facility Request
1125 Resident's Request to Remain in Facility
1126 Physician's Assessment
1127 Fire Marshal/State Fire Marshal Notification
1129 Fire Suppression Authority Notification
2382 Assisted Living Facilities Checklist
2383 Alzheimer's Certification Checklist
2384 Life Safety Code Checklist for Type A & B Facilities - 40 TAC §92.61
2385 Life Safety Code Checklist for Small Type A Facilities - 40 TAC §92.61
2386 Life Safety Code Checklist for Small Type B Facilities - 40 TAC §92.61
2387 Life Safety Code Checklist for Large Type A Facilities - 40 TAC §92.61
2388 Life Safety Code Checklist for Large Type B Facilities - 40 TAC §92.61
2389 Life Safety Code Checklist for Small Facilities - 40 TAC §92.62
2390 Life Safety Code Checklist for Large Facilities - 40 TAC §92.62
2391 Life Safety Code Checklist for All Initial Inspections - 40 TAC §92.63
2392 Life Safety Code Checklist for Alzheimer's Certification - 40 TAC §92.53
3100 Information Regarding Authorized Electronic Monitoring for Assisted Living Facility
3613-A SNF, NF, ICF/IID, ALF, ADC and DAHS Provider Investigation Report with Fax Cover Sheet
3641 Alzheimer's Assisted Living Disclosure Statement
3647 Assisted Living Disclosure Statement
3707 Fire Report for Long Term Care Facilities
3708 Amelioration Request
3720 Application for State License to Operate a Long-Term Care Facility
3721 Application to Certify Long-Term Care Facility for Alzheimer's Disease and Related Disorders or Alzheimer's Assisted Living Facility
4719 Fire Drill Report

Informacion in espanol = form also available in Spanish.