DMH Licensed Inpatient Facility Incident Notification Forms

DMH Incident Notification Forms

All licensed acute private and general hospitals with inpatient psychiatric units are required to notify the Licensing Division of incidents or conditions that occur on the unit no later than the next business day.  When an incident is known to have occurred thirty (30) days after discharge it should be reported on the appropriate incident form as soon as possible.  Incidents or conditions that should be reported include but are not limited to:

1. Medicolegal death
2. Sexual assault or abuse
3. Physical assault or abuse
4. Attempted suicide resulting in serious physical injury
5. A felony
6. Restraint or seclusion practices not in accordance with DMH regulations which result in serious physical injuries
7. If the Person in Charge believes an incident is sufficiently serious or complicated as to require an investigation by the Office of Investigations.

(Please note: Intensive Residential Treatment Programs (IRTPs) should report incidents to DMH Child/Adolescent Division)

• Incident Report (for hospitals only)  
• 30 Days Post Discharge Report (for hospitals only)