Dhhs incident 2026

1. Click ‘Get Form’ to open the DHHS Incident and Death Report in the editor.
2. Begin by entering the Provider Agency Name, Consumer’s Name, and LME Client Record Number at the top of the form.
3. Fill in the Date and Time of the Incident. If unknown, select the appropriate option.
4. Complete the Consumer Information section, including Date of Birth, Gender, Diagnoses, and any relevant program enrollments.
5. In the Location of Incident section, specify where the incident occurred from the provided options.
6. Describe the incident in detail, addressing Who, What, When, Where, and How without disclosing other consumers' information.
7. If applicable, complete sections regarding Consumer Death or Other Incidents by checking relevant boxes and providing necessary details.
8. Finally, ensure that all required fields are filled out before submitting your report to your supervisor for review.

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