Get 5-2 Deceased Client-employee Report Form - Utah Department Of ... - Hspolicy Utah

This guide provides step-by-step instructions for completing the 5-2 Deceased Client-Employee Report Form from the Utah Department of Human Services. This form is essential for reporting the death of any eligible client or employee and must be filed promptly to ensure proper communication within the department.

Follow the steps to accurately complete the form.

1. Select the ‘Get Form’ button to access the form and open it in the document editor.
2. Begin by entering the name of the deceased individual in the designated field. This is a critical piece of information.
3. Next, provide the address of the deceased. Ensure that all details are accurate and complete.
4. You will then need to enter the date of birth and date of death. These dates are vital for official records.
5. Fill in the ‘O’ number associated with the deceased, if applicable, to reference their case adequately.
6. Record the name and contact information of the attending physician related to the deceased person's case.
7. In the next section, include the name and address of the parent, guardian, or partner of the deceased.
8. Indicate the service provider responsible, including their phone number for follow-up communication.
9. Specify the case status by selecting either ‘Open’ or ‘Closed.’ If closed, provide the closure date.
10. Clarify whether there was medical examiner involvement by marking ‘Yes’ or ‘No’ as relevant.
11. State whether additional documents, such as the deceased person's file or field notes, are attached. If not attached, provide a brief explanation.
12. Fill in the information for the referring worker, including their name and phone number.
13. Document the division and local address for future reference.
14. Record the supervisor's name and phone number, as this information is crucial for processing.
15. Provide a detailed account of the information related to the death in the space provided.
16. Finally, the reporter must sign and date the form along with providing their contact number for any necessary follow-ups.
17. Once all sections are complete, ensure that you save your changes, then download, print, or share the form as needed.

Complete necessary documents online to ensure timely processing.