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The document is an Incident Reporting Form for Kentucky's 1915(c) Home and Community Based Services (HCBS) Waiver Programs. It outlines the procedures for reporting critical and non-critical incidents involving waiver participants, including timelines for submission, required participant information, incident details, notifications to relevant entities, and risk mitigation strategies. The form emphasizes confidentiality and provides guidelines for documenting incidents to ensure participant safety and compliance with regulatory requirements.

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