INCIDENT MANAGEMENT PAPER INCIDENT REPORTING PROCESS

Introduction
Agencies serving individuals who are DDS eligible based on a diagnosis of ASD, Prader-Willi, or Smith-Magenis syndrome will be submitting incidents by completing a paper incident report and submitting it to the appropriate DDS service coordinator.  The following outlines the process for reporting an incident using a paper incident report.   
The incident reporting reference materials available on the mass.gov/dds website should be used by all providers when submitting a paper incident report.
Reporting Process Using a Paper Incident Report
1.	An event occurs that meets the definition of one of the incident categories.  The reporter should complete the initial report section of the incident report.  The provider needs to fax/scan and email the initial report within the required timelines for minor and major review incidents (1 day for major review and 3 days for minor review incidents from time of discovery) to the appropriate service coordinator for review.
2.	The service coordinator will review the initial report.   There may be communication between the service coordinator and provider before the final report is submitted.
3.	The provider faxes/scans and emails the completed final report section of the incident report within 7 calendar days of discovery of the incident.  
4.	The service coordinator completes their review of the incident and approves (with or without changes) or disapproves the incident. The completed incident report with review is faxed/scanned then emailed to the provider.
5.	If the incident report is disapproved, the provider needs to make requested changes to the report and fax/scan the email the revised report to the service coordinator.  The revised report is reviewed, and is either approved or disapproved.  
6.	If the incident report is again disapproved,   the provider should return to step 3 to complete the incident report process.  
7.	Once the incident report is approved, the service coordinator should scan and email to the appropriate regional risk manager, regardless of whether it requires a regional level of review.
8.	If the incident report does require a regional level of review, the regional risk manager should complete the regional review, scan and email to the service coordinator.
9.	The Regional Risk Manager will forward all major incidents to the Dir. Of Risk Management.  
10.	If there is no agency involved in providing services to an individual, then the assigned Service Coordinator  is responsible for completing  the paper incident reporting process as outlined above for all levels of incidents.  

Supporting documentation about guidelines for reporting, as well as the paper incident report  can be found at the mass.gov/dds website under Key Initiatives/See All/HCSIS/Incident Management link.  Shown below are the two sections available there that contain important documents to be used when completing an incident report.