Fillable Updating Patient Population (Texas Real Estate Contracts)

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Updating Patient Population (Texas Real Estate Contracts)

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The Texas Real Estate Commission (TREC) is an agency that governs real estate practices in the state of Texas USA. I its headquarters are located in Ausin Texas at 1700 North Congress.

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dshs.texas.gov
Updating Patient Population
Accurately recording a facility’s patient population is an important component of filling out
the COVID-19 Pandemic Enrollment since it shows how many patients each facility could
potentially vaccinate. When recording the total count of patients, provide the total count of
patients being served in the facility within the past calendar year. Only one patient should
be counted in the “total count of patients being served” even if they have had multiple visits
to the facility or if they have received multiple vaccines. To provide the most accurate
patient numbers as possible, it is recommended to pull information from digital patient
records system or billing, if that applies. If these resources are not available, an educated
estimate will suffice.
Below are instructions on how to adjust a facility’s patient population depending on your
enrollment status:
Enrollment In-Progress:
1) Provider can log-in to their enrollment and update this information as needed, along
with completing the remaining sections of the enrollment. The username is the
firstname.lastname of the person who registered the enrollment.
Enrollment Pending Approval:
1) A provider can call the COVID-19 Vaccine Help Desk (877) 835-7750, 8 a.m. to 5
p.m., Monday through Friday or email COVID19VacEnroll@dshs.texas.gov
to have
their enrollment unlocked in order to log-in and make the updates. In either case,
provide the following:
a. Site name and address
b. ImmTrac2 Org Code
Enrollment Approved:
1) Fill out the following form as accurately and complete as possible and email it to
COVID19VacEnroll@dshs.texas.gov
.
dshs.texas.gov
Patient Population Adjustment Form
Please fill out the following form completely to adjust the patient population for your
facility’s COVID-19 Vaccine Enrollment application. This is only to be filled out and emailed if
your facility has been approved. Each item of information requested is essential in being
able to update the application correctly. The facility information listed below must match the
information on the application. Filling out this form is not a guarantee that your future
vaccine allocations will be affected. Email the following completed form to
COVID19VacEnroll@dshs.texas.gov
.
Facility Information
Facility name:
Immtrac2 organization code:
Facility address:
City/state:
Zip Code:
Primary phone:
Primary email address:
Patient Population Information
Total patients
Long-term care facility residents (nursing home, assisted living, etc)
General adult population
General pediatric population
Adults 65 years of age or older
Healthcare workers
Critical/infrastructure workers (e.g., education, law enforcement, fire services)
People experiencing homelessness
Pregnant women
Racial and ethnic minority groups
Tribal communities
People who are incarcerated/detained
People living in rural communities
People who are underinsured/uninsured
People with disabilities
People with underlying medical conditions that are risk factors for severe COVID-19
illness
Military- veteran
Military- active duty/reserves
Other people at higher-risk for COVID-19
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Updating Patient Population (Texas Real Estate Contracts)

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Completed 9 January 2021

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