Long Term Care Facility Self Reported Incidents
The Centers for Medicare and Medicaid Services (CMS) requires long term care facilities to self report incidents occurring within their facility to the Office of Inspector General. For your convenience a Long Term Care Self-Reported incident Form was created by the Office of Inspector General. The use of this form is encouraged to promote continuity and consistency. Below are instructions on how to report such incidents.
||Self Reported Incidents Instructions
- Complete every section of the Self Reported Incident Form.
- If there is insufficient space to complete an answer, additional pages may be used.
- Attach all supporting documentation.
- Call your Office of Inspector General (OIG) Division of Health Care Enforcement Branch Office if you have any questions or to submit your completed Self Reported Incident Form.
To determine the appropriate enforcement branch please see Contact Information.