Please rate Dads Form 3647 11-2022
The disclosure statement describes a facility's policies and services in a uniform manner.
Memory care: if your facility advertises, markets, or promotes that it provides memory care services to residents, you must also complete HHSC Form 3650.
Alzheimer's: if your facility is certified to provide care to residents with Alzheimer's disease and related disorders, you must also complete HHSC Form 3641.
Addendum: you may not amend the statement, but you may attach an addendum to expand on your answers.
Copies: provide copies of and explain all applicable disclosure statements to anyone who requests information about your facility.
Visiting: the statement is not intended to take the place of visiting the facility, talking with residents, or meeting one-on-one with facility staff.
| Question | Answer |
|---|---|
| Form Name | Form 3647 |
| Form Length | 7 pages |
| Fillable? | Yes |
| Fillable fields | 372 |
| Avg. time to fill out | 60+ min |
| Edition | November 2022-E |
| Matches the agency's file | Yes, checked October 3, 2026 |
| Other names | 3647, Form 3647, HHSC 3647, Assisted Living Disclosure Statement |
| Official source | Form 3647 November 2022-E, Texas Health and Human Services Commission |
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Please rate Dads Form 3647 11-2022
