Get Opwdd 147 Fillable

The Opwdd 147 Fillable form is a crucial document used to report incidents, serious incidents, and allegations of abuse within care settings. This guide will provide you with a step-by-step approach to accurately complete the form online, ensuring you meet all necessary reporting requirements.

Follow the steps to effectively fill out the Opwdd 147 Fillable form online.

1. Click the ‘Get Form’ button to access the Opwdd 147 Fillable form. This will open the document in your online editor for completion.
2. Begin with Item 1 by entering the name of the agency responsible for the report. Ensure accurate spelling and completeness.
3. In Item 2, provide the facility name where the event occurred. Use 'N/A' if it is a non-certified site.
4. For Item 3, specify the program type by selecting the appropriate classification from the list provided.
5. Proceed to Item 4 and fill in the complete address of the identified facility or location.
6. Complete Item 5 by entering the phone number of the facility in the designated field.
7. Assign an incident/allegation reference number in Item 6. This number should help distinguish between incidents at different locations and for those involving multiple people receiving services.
8. In Item 7, indicate if a previous Opwdd 147 was submitted for the same event.
9. Enter the full name of the person receiving services in Item 8. Ensure to provide their last name followed by their first name.
10. List the date of birth of this person in Item 9.
11. Check the appropriate gender in Item 10 by marking 'M' for male or 'F' for female.
12. In Item 11, enter the identifying number used for the person by your agency, avoiding social security numbers.
13. Indicate medication usage in Item 12 by checking the relevant option.
14. Complete Item 13 by filling out the date and time when the incident or alleged abuse was observed or discovered.
15. If known, enter the date and time when the incident occurred in Item 14.
16. Provide the number of persons receiving services present at the incident in Item 15.
17. In Item 16, state the number of employees who were present at the time of the incident.
18. Classify the incident in Item 17 by checking the most applicable classification.
19. Describe the specific location of the incident in Item 18.
20. Item 19 requires a detailed description of the incident or allegation. Ensure clarity and avoid speculation.
21. In Item 20, list all immediate corrective actions taken to ensure safety.
22. Check the relevant boxes in Item 21 regarding law enforcement notification.
23. Refer to Item 22 for referrals made to the Statewide Central Register of Child Abuse and Maltreatment.
24. Provide residential address and phone number in Item 23 if not initiated at the residence of the person receiving services.
25. In Item 24, enter the name of the DDSO corresponding to the facility location.
26. Specify the type of residence in Item 25.
27. If the person is no longer at the original residential location, provide that information in Item 26.
28. Complete Items 27 and 28 with the name, title, and signature of the parties completing and reviewing the form.
29. List any notifications made in Item 29 according to the specific requirements outlined.
30. Record additional steps taken for the individual's safety in Item 30.
31. Complete Item 31 with the name and title of the party completing this section.
32. Provide the name of the assigned investigator for the incident in Item 32.
33. Finally, save your changes, download the completed form, print a copy for your records, or share it as needed.

Complete your Opwdd 147 Fillable form online today to ensure accurate reporting and compliance.