To: Sandhills Center Catchment Area Providers *Category A & B Providers Only* From: Pam Morgan, Quality Management Director Date: July 1, 2010 Re: Level I Incident Quarterly Report Reminder The DHHS Incident and Death Response system requires all Providers of publicly funded services licensed under G.S. 122-C (except hospitals), (Category A Providers) and Providers of publicly funded non-licensed periodic or community based mh/dd/sa services (Category B Providers) to adhere to Incident and Death Reporting requirements. This includes outpatient, residential, licensed day and day treatment providers. Failure to do so may result in DHHS taking administrative action against the provider’s license or authorization to provide services. Providers are required to report aggregate information on Level I incidents involving restrictive interventions, medication errors, and searches and seizures to the Host LME on a quarterly basis. The information must be submitted on the DHHS Level I Incident Quarterly Review Report Form, QM 11. See attached. Information on 4th quarter incidents (April-June) will be due no later than July 10, 2010. Reports should be completed for each site/service location within the Sandhills catchment area (Anson/ Harnett / Hoke / Lee / Montgomery / Moore / Randolph / Richmond counties). A Level I quarterly report must be submitted to the LME even if there have been no incidents of medication errors, restrictive interventions or search and seizures. Providers should indicate 0 incidents for this situation. If a provider has not provided services during this quarter a report must be submitted. This applies to all disability groups. Please send your reports to Angie Kivett at 108 W Walker Avenue, Asheboro, NC 27203, by email at firstname.lastname@example.org or by fax 336-625-3661. Angie may also be reached at 336-625-4351 Thank you for your cooperation!
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