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Long-Term Care Facility Self-Reported Incidents

The Centers for Medicare and Medicaid Services requires long-term care facilities to self report incidents occurring in their facilities to the Office of Inspector General. For your convenience a Long-Term Care Self-Reported incident form is available to promote continuity and consistency.

Self-Reported Incidents Instructions

  1. Complete every section of the Self Reported Incident Form.
  2. Please see the detailed instructions if you have any questions on how to complete the form.
  3. If you choose to complete electronically, simply open the form and save it to your computer. 
  4. If there is insufficient space to complete an answer, additional pages may be used.
  5. Attach all supporting documentation.
  6. You may submit the Self Reported Incident Form and any attachments via email, mail or fax.
  7. To determine the appropriate Division of Health Care Branch to submit your paperwork to, please see the Regional Map  and the corresponding Contact Information.
  8. If you have any questions, please contact your Division of Health Care Branch Office. 

Long Term Care Regulations and Statutes

Note that the Legislative Research Commission (LRC) maintains Kentucky Administrative Regulations (KAR) and Kentucky Revised Statutes (KRS).  Links to KARs and KRSs can change.  LRC maintains a website available to the public with a searchable database to obtain all active regulations and statutes.

Kentucky Revised Statutes  Search

Kentucky Administrative Regulations

Title 900
Cabinet for Health and Family Services
Department for Public Health
Chapter 2 Long-term Care

Chapter 6 Certificate of Need