Hfl incident 2025

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4.9 out of 5

339 votes

The document is a reporting form for incidents involving consumers under the care of the New Mexico Department of Health. It includes sections for personal information, details about the incident (such as type, date, and description), and initial actions taken by the agency to ensure health and safety. The form emphasizes the importance of notifying relevant authorities within 24 hours.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in the consumer's name, social security number, and address. Ensure that all fields marked in red are completed as they are required.
Indicate the consumer's competency level by selecting one of the options: High, Moderate, Low. Then, provide their date of birth and contact information.
In the section for Activities of Daily Living (ADLs), check all applicable boxes to indicate which areas the resident needs assistance with.
Select the type of alleged incident from the provided options and fill in details about the person responsible for care at the time of the incident.
Document any witnesses present during the incident and provide a detailed description of what occurred before, during, and after.
Complete sections regarding initial actions taken by your agency and plans for further actions. Ensure all necessary signatures are included before submission.

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Versions	Form popularity	Fillable & printable
2009	4.9 Satisfied (339 Votes)

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