Dads Form 3647 – Fill Out and Use This PDF

Dads Form 3647 PDF Details

The Texas HHSC Form 3647, the Assisted Living Disclosure Statement, was introduced in July 2013 by the Texas Department of Aging and Disability Services. It requires all licensed assisted living facilities (ALFs) in Texas to present their services, policies, and fees in a standardized format. This gives prospective residents and their families a consistent basis for comparing facilities before making a placement decision.

Form 3647 covers six topic areas:

• Pre-admission process – facility tours, applications, home assessments, and medical record reviews
• Services in the base rate – daily meals, housekeeping, activity programs, and personal laundry
• Optional additional services – beauty and barber services, transportation to medical appointments, and minor nursing care
• Admission and discharge rules – grounds for discharge, transfer procedures, and deposit refund terms
• Aging-in-place protocols – how the facility handles residents who need more care over time
• Staffing and residents' rights – staff training standards, physical environment safety, and legal rights protections

Request a completed Form 3647 from each facility you are evaluating. Compare responses across the six areas, especially Section C (base-rate services) and Section D (optional add-ons), to understand true costs. For related documents, visit our Texas DADS forms collection.