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Incident death report 2026
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- Click ‘Get Form’ to open the incident death report in the editor.
- Begin by filling in the T/RBHA NAME and PROVIDER NAME at the top of the form. Ensure all information is accurate.
- In the TYPE OF REPORT section, check all applicable boxes such as Death, Suicide, or Accident. This categorization is crucial for proper reporting.
- Complete the ASSIGNED MEMBER OR NON-ENROLLED BEHAVIORAL HEALTH RECIPIENT INVOLVED IN INCIDENT section with details like Name, Age, and AHCCCS ID.
- Provide detailed INCIDENT DETAILS including Date and Time of Incident, Address & Location, and a description of what occurred before and after the incident.
- Document any actions taken post-incident in the DESCRIPTION OF INCIDENT section to help prevent future occurrences.
- Finally, ensure that all sections are completed before saving your form. Use our platform’s features to easily save or submit via email.
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Related links
Below is a list of suggested documentation to guide your death investigation. Not all documents may be relevant to your investigation.Read more
You can report it by contacting us at (323) 343-3103* or by using our online reporting form, even if you do not have official documentation. We will guide youRead more