Get Ky Home And Community Based Services (hcbs) Waiver Programs - Incident Reporting Form 2019-2025

Filling out the Kentucky Home and Community Based Services (HCBS) Waiver Programs - Incident Reporting Form online is an essential process for documenting incidents involving waiver participants. This guide will provide clear and instructive steps to help you navigate the form with confidence.

Follow the steps to complete the form efficiently.

1. Press the ‘Get Form’ button to access the form and open it in your chosen editor.
2. Begin with the reporting source section. Fill in the waiver participant information, including the program type and the participant's details, such as their first name, last name, date of birth, and/or Medicaid number as applicable.
3. Indicate whether the participant-directed services are applicable by selecting 'Yes' or 'No'.
4. Proceed to the incident information section. Here, select whether the incident is classified as critical or non-critical. Specify the type of incident and provide detailed dates and times regarding both the incident and its discovery.
5. Continue filling out the location type by selecting the appropriate option, and specify the address of the incident. Include a clear description of what occurred, naming any staff involved.
6. In the notifications section, list all entities that were notified about the incident, specifying contact names and notification methods.
7. If relevant, provide details of the alleged perpetrator, including their name and relationship to the waiver participant.
8. Document any witnesses present during the incident, including their names, addresses, and relationships to the waiver participant.
9. Complete the risk mitigation section by discussing the participant’s current status, prevention possibilities, and immediate actions taken to ensure their safety.
10. Finally, sign and date the form in the designated area before submitting it as required.

Complete your incident reporting form online today to ensure effective documentation and submission.