SDM Program: ICF/IID Program Provider Responsibilities

It is the responsibility of each intermediate care facility (ICF/IID) community program provider to submit the required forms and supporting documentation to the Surrogate Decision-making Program (SDMP) when a person they serve lacks the capacity to make certain treatment decisions for himself or herself and have no legal guardian or surrogate decision maker.

Forms

• Form 2700, Application for a Treatment Decision by a Surrogate Consent committee
• Form 2705, Certification of Need for Major Medical Treatment
• Form 2710, Certification of Need for Major Dental Treatment
• Form 2715, Certification of Need for Psychoactive Medication Treatment
• Form 2720, Certification of Need for Highly Restrictive Procedure
• Form 2725, List of Persons to Receive Notification
• Form 2726, Notification of a Surrogate Consent Committee Hearing
• Form 2727, Waiver of Designation as Surrogate Decision Maker
• Form 2749, Submitting an Application Packet for a Treatment Decision
• Form 2750, Surrogate Decision Making Program Data Form

Learn About the SDMP

The law and rule pertaining to the SDMP is found in:

• Texas Health and Safety Code, Chapter 597, Capacity of Clients to Consent to Treatment
• Texas Administrative Code, Title 26, Part 1, Chapter 261, Subchapter J, Surrogate Decision Making