Hospital Self Assessment Survey

The Hospital Self Assessment Survey is now available to download and either fax, email, or ground service (USPS, Lonestar, FedEx, etc) to our office. Survey must be completed and emailed/faxed/snail mailed in by September 30 (postmarked by September 30 w/snail mail) to qualify for the 5 star award.

Hospital Self Assesment Survey (115K PDF)

Please follow the following instructions when completing the self-assessment survey:

  • You only need to send in the requested documents if you did not complete the survey last year or unless the documents have been updated since last year’s submission.
  • When entering the Name of Facility, please include the full name of the facility. (exp. Texas Health Harris Methodist Hospital Southwest Fort Worth)
  • Please answer the question truthfully. This is the only way we will be able to assist you in your duties as a birth registration facility.
  • If you are including a large number of documents, we suggest that using USPS, Lonestar, or some other conventional mail service, as appose to fax or email.
  • When you have completed the survey and have all your documents you can send it to us in one of the following methods:
    • By USPS, Lonestar, FedEx, etc. to:
      Texas Department of State Health Services Vital Statistics Unit - MC1966
      Attention: Field Services
      P.O. Box 149347
      Austin, Texas 78714-9347
    • By Fax: 512-458-7538
    • By Email to 

If you have any particular question please email your area representative for clarification.


*External links to other sites are intended to be informational and do not have the endorsement of the Texas Department of State Health Services. These sites may also not be accessible to persons with disabilities.

Last updated February 24, 2017