Ny doh dss 2026

1. Click ‘Get Form’ to open the ny doh dss in the editor.
2. Begin by entering the Facility Name and County at the top of the form. This information is essential for identifying the location of the incident.
3. Fill in the Date and Time of the Incident accurately. This helps establish a timeline for any investigations.
4. In the Resident Name section, provide the name of the affected resident. Then, circle all applicable levels of care from AH, EHP, ALR, EALR, SNALR, ALP.
5. For Reportable Incidents, check all relevant boxes that apply to your situation. If necessary, complete an addendum for incidents like resident death or suicide attempts.
6. Describe the Incident in detail in Section II. Include specifics about injuries and first aid provided.
7. Document Immediate Actions Taken in Section III to outline medical treatments or actions performed post-incident.
8. Complete Sections IV and V regarding QA Review actions and care providers involved.
9. Finally, ensure that both Administrator/Operator’s Signature and Resident’s Signature are included before submitting.

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