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Building Inspections Department 1520 K Avenue Plano, TX 75074 Tel: 972.941.7140 building inspections. Ambulatory HEALTH CARE FACILITY STATEMENT OF DISCLOSURE This form documents information concerning
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How to fill out ambulatory health care facility

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To fill out an ambulatory health care facility form, follow these steps:
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Start by writing the name and address of the facility at the top of the form.
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Provide details about the purpose and nature of the facility, such as the type of services offered and the medical specialties available.
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Include information about the facility's operating hours, appointment system, and any after-hours emergency services.
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Describe the facility's staffing, including the number and qualifications of healthcare professionals working there.
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Provide details about the facility's physical resources, such as the number of patient examination rooms, diagnostic equipment available, and any specialized facilities like operating rooms or imaging centers.
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Outline the facility's infection control and safety measures, including procedures for sterilization, waste disposal, and patient safety protocols.
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Explain the facility's policies regarding patient confidentiality, informed consent, and medical record keeping.
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Include any additional information that may be relevant to the evaluation of the facility, such as accreditation or certification status, affiliations with other healthcare organizations, or quality improvement initiatives.
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Finally, review the filled-out form for completeness and accuracy before submitting it.
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Note: The specific requirements and sections of the form may vary depending on the regulatory body or organization requesting the information. It is important to consult the instructions provided with the form to ensure all necessary information is provided.

Who needs ambulatory health care facility?

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Ambulatory health care facilities are needed by various stakeholders, including:
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- Patients who require non-emergency medical services or diagnostics on an outpatient basis.
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- Individuals seeking specialized medical care or consultations with healthcare professionals.
04
- Healthcare providers who want to establish a facility to offer ambulatory care services.
05
- Regulatory bodies or government agencies responsible for healthcare oversight and licensing.
06
- Insurance companies or third-party payers who need to assess and approve healthcare facilities for coverage and reimbursement purposes.
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- Researchers or academics studying healthcare delivery and outcomes.
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- Public health organizations or policymakers involved in planning and assessing healthcare resources in a community or region.
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An ambulatory health care facility is a medical facility that provides outpatient services to patients who do not require overnight hospitalization.
Providers of outpatient medical services such as clinics, surgical centers, and other healthcare providers that operate outside of a hospital setting are required to file for an ambulatory health care facility.
To fill out an ambulatory health care facility application, gather relevant documentation, provide detailed information about the facility, services offered, and comply with state regulations and guidelines.
The purpose of an ambulatory health care facility is to provide high-quality medical care to patients without the need for extended stays, improving access to healthcare services.
Information that must be reported includes facility name, address, services offered, ownership information, staff qualifications, and compliance with health regulations.
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