Get Isdh Program Advisory Ltc- 2011 -01 - State Of Indiana - In

This guide provides a clear and supportive approach to filling out the ISDH Program Advisory LTC-2011-01 form online. It outlines the necessary steps and sections, ensuring that users can effectively report a reasonable suspicion of a crime against a resident in a long-term care facility.

Follow the steps to successfully complete the form.

1. Click the 'Get Form' button to obtain the form and open it in the editor.
2. Review the purpose of the form. Familiarize yourself with the obligations and requirements to report a reasonable suspicion of a crime against a resident.
3. Fill in the facility information section, including the facility name, address, and contact details.
4. Provide your details as the reporter. Include your name, title, and contact information.
5. Document the specifics of the incident, including the date and time, residents involved, and a brief description of what occurred.
6. Indicate the type of injury if applicable and describe any immediate action taken in response to the incident.
7. Select the type of report being submitted: Initial, Follow-up, or Initial with Follow-up.
8. Review the completed information for accuracy and completeness.
9. Save your changes, and you can choose to download, print, or share the completed form as needed.

Complete and submit your reporting documents online to fulfill your responsibilities.