Instructions for Six Month Reportable Incident Data Report Form
If Submitting by E-mail |
If Submitting by Fax |
| 1. Save blank form | 1. Save blank form |
| 2. Fill in and complete the report form | 2. Fill in and complete the report form |
| 3. Save file under a new name | 3. Save file under a new name |
| 4. Attach to e-mail address shown on Page 1 of the report form | 4. Send to fax number shown on Page 1 of the report form |
Community Mental Health Agency
Type 1 Residential Facility
Inpatient Psychiatric Service Providers