These instructions and fax forms apply to reporting all incidents, and suspected abuse, neglect, mistreatment and misappropriation of patient or resident property under the Patient Abuse Law. Generally, facility reports must be made using the Health Care Facility Reporting System (HCFRS), in accordance with applicable state law, licensure regulations and DPH reporting guidelines.

Licensed facilities must notify DPH immediately by phone in the event of:

  • Death that is unanticipated, not related to the natural course of illness or condition, or that is the result of an error or other incident
  • Full or partial evacuation due to fire, flood, utility failure or other disaster
  • Code Black (Hospitals only)

During business hours call the main Intake number 617-753-8150; after business hours call 617-363-0755 or 617-469-1111.

Health Care Facility Reporting System (HCFRS)

The Health Care Facility Reporting System (HCFRS) is a web-based system that facilities must use to report incidents, and allegations of abuse, neglect and misappropriation.

Information on how to use HCFRS is posted on-line, below.  Facilities should review the user manuals and training videos prior to first submitting a report, or if they have questions on how to use HCFRS.

Forms and Instructions for Enrolling and Deleting Users

Facilities must register with the EOHHS Virtual Gateway (“VG”) through DPH to first use HCFRS.  Once registered, a facility must work through DPH to add or delete an “access administrator” or add an individual user.

ACTION:

PAPER FORMS: 

Forms Mailed by Facility to DPH:

URF:

URF from Access Administrator to VG

LOG-ON: 

Individual User Log-On

FORM A:
VG Services Agreement

FORM B:
VG Access Admin Form

FORM C:
DPH Facility Agreement

FORM D:
DPH User Agreement

 INITIAL FACILITY ENROLLMENT

Initial Facility Enrollment

X

X

X

X

X

X

 ADDING NEW USERS – ENROLLED FACILITY:

Add Access Administrator

 

X

 

X

X

X

Add Individual User

 

 

 

X

X

X

 DELETING USERS:

Delete Access Administrator

 

X

 

 

X

 

Delete Individual User

 

 

 

 

X

 

HCFRS Enrollment Forms

HCFRS Program Initial Enrollment:

STEP 1:  Facility/Program completes and submits four forms to DPH by mail.  Note that for initial licensure, these forms must be submitted with the licensure application:

A. “Virtual Gateway Services Agreement”

B. “Virtual Gateway Access Administrator Designation Form” (minimum 2 Access Administrator’s per program)

C. “DPH HCFRS Facility/Program Agreement”

D. “DPH HCFRS Authorized User Agreement” (one by each individual user, including Access Administrators)

Send these forms to:
DPH – HCFRS Enrollment
99 Chauncy Street, 11th Floor
Boston, MA 02111

(NOTE:  Applicants with new facilities or programs not yet licensed should leave the “License Number” on Forms C and D blank.)

STEP 2:  Facility/Program completes and submits a User Request Form (“URF”) to the Virtual Gateway by email.  (The facility/program’s Access Administrator will receive the URF, an Excel spreadsheet, from DPH by email once the Virtual Gateway approves their user application.)

Send the URF by email to:  virtualgatewayhelpdeskfaxes@massmail.state.ma.us

STEP 3:  Each individual facility/program user must log on to the Virtual Gateway website within seven days of receiving their user name and temporary password by email from the Virtual Gateway.



Adding an a New HCFRS Access Administrator:

STEP 1:  Facility/Program completes and submits two forms to DPH by mail:

B. “Virtual Gateway Access Administrator Designation Form” (minimum 2 AA’s per facility)”

D. “DPH HCFRS Authorized User Agreement” (one by each individual user)”

Send these forms to:
DPH – HCFRS Enrollment
99 Chauncy Street, 11th Floor
Boston, MA 02111

STEP 2:  Facility/Program Access Administrator completes and submits a User Request Form (“URF”) to the Virtual Gateway by email.  (The facility’s Access Administrator will receive the URF, an Excel spreadsheet, from DPH by email once the Virtual Gateway approves their user application.)

Send the URF by email to:  virtualgatewayhelpdeskfaxes@massmail.state.ma.us

STEP 3:  Each individual facility/program user must log on to the Virtual Gateway website within seven days of receiving their user name and temporary password by email from the Virtual Gateway.



Adding a New HCFRS User Instructions:

STEP 1:  Facility/Program completes and submits one form to DPH by mail:

D. “DPH HCFRS Authorized User Agreement” (one by each individual user)”

Send this form to:
DPH – HCFRS Enrollment
99 Chauncy Street, 11th Floor
Boston, MA 02111

STEP 2:  Facility/Program Access Administrator completes and submits a User Request Form (“URF”) to the Virtual Gateway by email.  (The facility’s Access Administrator will receive the URF, an Excel spreadsheet, from DPH by email once the Virtual Gateway approves their user application.)

Send the URF by email to:  virtualgatewayhelpdeskfaxes@massmail.state.ma.us

STEP 3:  Each individual facility/program user must log on to the Virtual Gateway website within seven days of receiving their user name and temporary password by email from the Virtual Gateway.


Deleting an HCFRS Access Administrator Instructions:

STEP 1:  Facility/Program completes and submits one form to DPH by mail:

B. “Virtual Gateway Access Administrator Designation Form”

Send this form to:
DPH – HCFRS Enrollment
99 Chauncy Street, 11th Floor
Boston, MA 02111

STEP 2:  Facility/Program Access Administrator completes and submits a User Request Form (“URF”) to the Virtual Gateway by email.  (The facility/program’s Access Administrator will receive the URF, an Excel spreadsheet, from DPH by email once the Virtual Gateway approves their user application.)

Send the URF by email to:  virtualgatewayhelpdeskfaxes@massmail.state.ma.us



Deleting an HCFRS User Instructions:

STEP 1:  Facility/Program Access Administrator completes and submits a User Request Form (“URF”) to the Virtual Gateway by email.  (The URF for deleting a user, an Excel spreadsheet, is available on the DPH HCFRS website.)

Send the URF by email to:  virtualgatewayhelpdeskfaxes@massmail.state.ma.us


Fax Forms

A facility that is filing a report regarding an incident that occurred in another facility must submit that report by fax, using the appropriate form below.

HCFRS Training Manuals and Videos

An HCFRS User Manual and four training videos contain helpful information on how to report using HCFRS.  Users should consult this information if they have a question as to how to submit a report:

Training Video Instructions.  If you are using JAWS screen reader, Mozilla Firefox browser is recommended.

To Pause or Restart the video at any time - press the Space Bar.
To skip to the Next Scene - press the right arrow key. To go back to a Previous Scene - press the left arrow key.
To mute the audio - press the letter M.
To return to the beginning of the video - press the Home key.