This version of the form is not currently in use and is provided for reference only. Download this version of Form 6104 for the current year.
This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is a Form 6104?
A: Form 6104 is an Incident Report for Freestanding Emergency Medical Care Facilities in Texas.
Q: Who needs to file Form 6104?
A: Freestanding Emergency Medical Care Facilities in Texas need to file Form 6104.
Q: What is the purpose of Form 6104?
A: The purpose of Form 6104 is to report incidents that occur at Freestanding Emergency Medical Care Facilities.
Q: What information is included in Form 6104?
A: Form 6104 includes details about the incident, including date, time, location, and a description of what occurred.
Q: How do I obtain a copy of Form 6104?
A: You can obtain a copy of Form 6104 from the Texas Department of State Health Services.
Q: Are there any deadlines for filing Form 6104?
A: Yes, Form 6104 must be filed within 7 days of the incident.
Q: Are there any fees associated with filing Form 6104?
A: No, there are no fees associated with filing Form 6104.
Q: What happens after I file Form 6104?
A: After filing Form 6104, the incident will be reviewed by the Texas Department of State Health Services.
Form Details:
Download a fillable version of Form 6104 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.