Get Ia 470-4698 2016

The IA 470-4698 is a critical incident report form utilized by the Iowa Department of Human Services to document incidents involving Medicaid members. This guide will help you navigate the various sections of the form and provide clear instructions for completing it online.

Follow the steps to successfully complete the IA 470-4698 online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Fill in the date received and the incident ID at the top of the form. This information helps track the report.
3. Indicate the staff reviewer who will assess the incident. This should be a designated individual tasked with reviewing the report.
4. Complete the case manager and service program sections by providing the necessary details about the Medicaid member involved.
5. Populate the reporting party information, including their first and last name, title, email, and phone number for follow-up communications.
6. Specify the managed care organization associated with the Medicaid member, selecting from the listed options.
7. In the incident section, fill out details such as the date of the incident, whether it was witnessed, the time of occurrence, and location.
8. Describe the incident in detail, using clear and concise language. Include all relevant circumstances surrounding the incident.
9. Check applicable boxes to indicate whether services were provided, and whether the case manager or guardian was informed about the incident.
10. Finally, review your entries for accuracy. Users can save changes, download, or print the completed form before submission.

Complete the IA 470-4698 online to ensure accurate reporting of critical incidents.