Form 1085, 2013, State Of Texas Emergency Assistance Registry
Download a blank fillable Form 1085, 2013, State Of Texas Emergency Assistance Registry in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 1085, 2013, State Of Texas Emergency Assistance Registry with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Texas Department of Aging
Form 1085
and Disability Services
March 2013
State of Texas Emergency Assistance Registry (STEAR)
Contact Information for Data Collector
Organization:
Contact Name:
Contact Area Code and Telephone No.
Contact Email:
STEAR Facility Registration Form – For use by assisted living facilities, nursing homes, etc.
One form should be completed for each facility.
1. Name of the facility
2. Street address
Apt/Suite No.
3. City
4. ZIP code
5. County
6. Contact area code and telephone
7. Estimated daily average census
8. Do you have an evacuation plan for your facility residents if there is an emergency?..........................................
Yes
No
9. Are there any additional comments or notes I should enter into your record?
Forms can be filled electronically using Adobe Reader or
Fax completed form to 866-557-1074
Acrobat and saved as uniquely named PDF files.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal