Get Significant Events Reporting System Guide - New Mexico ... - Health State Nm

This guide serves as a comprehensive resource for users tasked with filling out the Significant Events Reporting System Guide for New Mexico. It is designed to assist individuals with various levels of experience in effectively completing the form online.

Follow the steps to successfully complete the Significant Events Reporting System Guide.

1. Select the ‘Get Form’ button to access the significant events reporting form and open it in your editing tool.
2. Begin by filling out Line 1 with the date you are submitting the report. This is essential for tracking purposes.
3. Complete Line 2 by providing the individual's name, the last four digits of their Social Security number, and their date of birth.
4. On Line 3, check the appropriate box for the individual’s Class Member Status and indicate if they are a DD Waiver recipient.
5. List your agency's name on Line 4 for identification.
6. Provide the agency contact person’s information, including their phone number and email address, on Line 5.
7. Specify the type of residential and day services the individual receives in Line 6.
8. In Line 7, select the region where the individual resides.
9. Enter the date of the significant event in Line 8 in the format of month, day, and year.
10. Document the time of the significant event in Line 9 and indicate whether it occurred in the AM or PM.
11. Detail the location of the significant event on Line 10.
12. In Line 11, list the name and title of the staff person(s) involved in the significant event.
13. On Line 12, check the box that corresponds to the type of significant event that occurred.
14. If applicable, complete Line 13 regarding Out of Home Placement with the necessary details of the situation.
15. Provide a description of the significant event and the actions taken in Line 14, ensuring to include any pertinent information.
16. Finally, on Line 15, describe any assistance needed from the Developmental Disabilities Support Division (DDSD) regarding the event.

Complete the Significant Events Reporting System Guide online to ensure timely and accurate reporting of significant events.