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Ethics/Medical Committee Reporting Form

Ethics/Medical Committee Reporting Form Page | 1

According to Texas Health & Safety Code Section 1, Subchapter B, Chapter 166, health care facilities must report information regarding ethics or medical committee processes in instances in which an attending physician refuses to honor an advance directive or health care decision made by or on behalf of certain patients. Facilities must submit a report no later than 180th day after the written notice regarding the review process required under Section 166.046(b), as amended by 88(R) HB 3162, is provided.


Information collected in this reporting form will only be used to meet statutorily mandated reporting requirements. Any patient information collected in this form is strictly confidential and will not be used to identify the patient by any means. 

Questions within this reporting form refer to written notice required by Health & Safety Code Section 166.046(b), as amended by 88(R) HB 3162, regarding ethics or medical committee review of a physician's refusal to honor an advance directive or health care or treatment decision. Additionally, Question 1 has been included to provide a contact person for HHSC in case any further inquiries arise on the reported information.
To preview the questions on this form please click the following link: Ethics/Medical Committee Reporting Form-Blank