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Get AZ PM Form 7.4.1 2012-2024

Idents and deaths occurring in facilities licensed by the ADHS Office of Behavioral Health Licensure (OBHL) must be verbally reported to OBHL (602-364-2595) within 24 hours and reported in writing to OBHL (FAX 602-324-5872) within 5 working days. Incidents, accidents and deaths, including those occurring during a T/RBHA or provider sponsored prevention activity affecting non-enrolled persons must be reported in writing to the TRBHA within 48 hours, or two business days. You may email the form to.

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