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REPORTING

Chapter 395 F.S. currently requires reporting of the following types of incidents to the Agency by hospitals and ambulatory surgical centers at this time. They must also report any injuries of which they are aware occurring through any health care service, which would include nursing homes, home health organizations, doctors' offices, dentists' offices, or any other purveyor of health care service. Additionally, Chapter 641.55 requires similar reporting of patient injury incidents by HMOs. The patient injury incidents are reported through two different types of reporting mechanisms:

The facility Annual Report -- must reflect all adverse incidents according to statutory definition, which occur in the facility in the course of a calendar year, due in to the Agency, Division of Health Quality Assurance, after the first of each year for the previous year; and

The Code 15 Report -- reports in detail and analyzes each serious patient injury, as defined by statute, and due in to the Agency, Division of Health Quality Assurance, within 15 days from the time of the occurrence of the injury.

Reporting Forms and Information

Code 15 Report Form
(126K DOC)*

Code 15 Reporting Instructions
(25K PDF)

Code 15 Report Form -
HMOs
(141K DOC)*

Adverse Incident Reporting Guide
(31K PDF)
Code 15 Extension Form
(83K DOC)
Annual Report Cover Letter - December 24, 2003
(17K PDF)
Annual Report Form
(315K DOC)
Annual Report Instructions
(36K PDF)
Contacts- Risk Management Program Staff
(19K PDF)
   *  Computerized template in Word format.

Click above to view selection.Note: For viewing our downloadable 'pdf' files, it is recommended that you use Adobe Reader 4.0. Adobe Reader is available at www.adobe.com .

Updated May 5, 2008