Texas Health and Human Services Incident or Illness Report
This file is the Texas Health and Human Services Incident or Illness Report Form 7239. It is used to record required information when a child sustains an injury, falls ill, or there is a reportable incident. The form includes various sections for detailed incident descriptions, medical treatments, and notifications.
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How do I fill this out?
Complete the appropriate sections of the form based on the specific incident. Ensure all required fields are filled accurately and thoroughly. After filling out the form, notify the necessary parties and keep the form on file as required.
How to fill out the Texas Health and Human Services Incident or Illness Report?
1
Identify the type of incident, injury, or illness to determine the relevant sections to complete.
2
Fill in the general information in Section I.
3
Complete the specific sections (II, III, IV) based on the type of incident.
4
Sign and date the form in Section V, and obtain acknowledgment from the parent or guardian in Section VI.
5
Notify relevant parties and retain the form for your records.
Who needs the Texas Health and Human Services Incident or Illness Report?
1
Childcare centers need it to document incidents and illnesses involving children.
2
Parents need it to stay informed about any injuries or illnesses their child may have sustained.
3
Healthcare providers need it to understand the details of the incident for medical treatment.
4
Regulatory agencies need it to ensure health and safety standards are being met and maintained.
5
Employees need it to record any communicable diseases they contract at the workplace.
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What are the instructions for submitting this form?
After filling out the form, notify parents as required by minimum standards and keep the form on file at the operation. For incidents requiring hospitalizations or involving communicable diseases, report to the relevant authorities. Submit the form to the following addresses: Email: incidents@hhs.texas.gov Fax: (512) 438-2728 Physical Address: Texas Health and Human Services, Incident Reporting, Mail Code E-249, P.O. Box 149030, Austin, TX 78714-9030. Make sure to follow up with relevant parties to ensure all necessary actions have been taken.
What are the important dates for this form in 2024 and 2025?
Form 7239 must be completed at the time of an incident or onset of illness, with reporting to relevant parties promptly. Stay updated with annual reviews to ensure compliance.
What is the purpose of this form?
The purpose of the Texas Health and Human Services Incident or Illness Report Form 7239 is to document any injuries, illnesses, or incidents involving children in a childcare operation. By completing this form, childcare centers can provide detailed records that assist healthcare providers in delivering appropriate medical care. Additionally, it ensures compliance with regulatory standards, helps identify potential safety issues, and facilitates effective communication with parents and guardians.
Tell me about this form and its components and fields line-by-line.
- 1. Director's Name: The name of the director or person in charge of the childcare operation.
- 2. Operation No.: A unique identification number assigned to the childcare operation.
- 3. Parent(s) Notified: Indicates whether the parents of the child involved were notified, along with the date of notification.
- 4. Date of Incident or Illness: The date when the incident or illness occurred.
- 5. Time of Incident or Illness: The specific time the incident or illness took place.
- 6. Child's Full Name: The full name of the child involved in the incident or illness.
- 7. Child's Date of Birth: The date of birth of the child involved.
- 8. Caregiver in Charge: The caregiver responsible for the child at the time of the incident or illness.
- 9. Describe the Injury or Risk: A detailed description of the injury sustained or the risk identified.
- 10. How did the Incident or Injury Occur?: An explanation of how the incident or injury occurred.
- 11. Additional Staff Present or Witness: Names of any additional staff who were present or witnessed the incident or injury.
- 12. First Aid Provided: Indicates whether first aid was provided and the type of first aid given.
- 13. EMS Called: Indicates whether Emergency Medical Services were called and the time they were contacted.
- 14. Medical Treatment: Details about any medical treatment received, including hospitalizations, medications administered, and doctor's recommendations.
What happens if I fail to submit this form?
Failing to submit this form can lead to non-compliance with regulatory standards and potential legal consequences. It may also result in inadequate medical treatment and poor communication with parents or guardians.
- Regulatory Non-Compliance: Failure to submit the form as required may result in penalties or other enforcement actions from regulatory agencies.
- Inadequate Medical Response: Incomplete documentation can hinder the ability of healthcare providers to deliver appropriate treatment.
- Poor Communication: Not submitting the form reduces transparency and can strain relationships with parents or guardians.
How do I know when to use this form?
- 1. Injury Requiring Medical Treatment: Complete the form to document any injuries requiring medical attention or hospitalization.
- 2. Incident Risking Harm: Use the form to report incidents that place or may place a child at risk of injury or harm.
- 3. Illness Requiring Hospitalization: Document any illness that necessitates hospitalization through this form.
- 4. Communicable Disease: Record cases where a child or employee contracts a communicable disease, including necessary notifications.
Frequently Asked Question
How do I fill out the Incident or Illness Report Form 7239?
Identify the type of incident or illness, fill out the relevant sections, and ensure all required information is accurate before notifying the necessary parties.
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What sections should I fill in for an illness requiring hospitalization?
Complete Sections I, III, V, and VI for an illness requiring hospitalization.
Do I need to notify parents when filling out the form?
Yes, you must notify parents according to the minimum standards after completing the form.
How do I record a communicable disease on this form?
For communicable diseases, fill in Sections I, IV, V, and VI with the relevant information.
Can I download the edited PDF from PrintFriendly?
Yes, you can download your edited PDF directly from PrintFriendly for your records.
What is the Director's role in completing this form?
The Director or person in charge must review the information, verify accuracy, and sign the form in Section V.
How do I notify the Health Department about a communicable disease?
Complete Section IV and include the date the Health Department was notified.
Related Documents - Incident or Illness Report Form 7239
Incident Injury Report for Child Care Services
The Incident/Injury Report for Child Care is a critical document designed to document all incidents or injuries occurring in child care settings. It ensures compliance with Ohio Department of Job and Family Services regulations and provides essential information for caregivers and parents. Proper completion and submission of this form help maintain a safe environment for children and facilitate effective communication with parents.
