Get Ia 470-4698 2018

Filling out the IA 470-4698 is an essential process for reporting critical incidents related to Medicaid services. This guide will provide clear, step-by-step instructions to help you complete the form accurately and efficiently.

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

1. Click the ‘Get Form’ button to obtain the IA 470-4698 online and open it in your browser.
2. Begin by filling out the 'Date Received' and 'Incident ID' sections at the top of the form. Ensure you have the correct dates and unique IDs for accurate record-keeping.
3. Complete the 'Staff Reviewer' and 'Case Manager' fields. These should include the names of the individuals involved in reviewing the incident report.
4. In the 'Reporting Party' section, fill in the necessary details about the provider or facility including the 'National Provider Identifier' and contact information.
5. Specify the 'Incident Status' by selecting from the given options: Initial, Completed, or Additional information added.
6. Provide information regarding the 'Managed Care Organization' involved in this incident. Choose from the options provided.
7. Record the 'Date Incident Occurred' and 'Date Incident Discovered'. Be sure to include the times if needed.
8. Detail the 'Location of Incident' and select the appropriate 'Location Type' from the dropdown choices.
9. In the 'Witnesses' section, list any individuals who were present during the incident, including their names and relationships.
10. Complete the 'Incident Description' section. Be clear and concise, covering who, what, when, where, and how the incident occurred.
11. Fill out the 'Incident-Specific Resolutions' section, checking all applicable resolutions and providing details of any actions taken.
12. Once all necessary sections have been completed, review your form for accuracy. You can then save changes, download if needed, print, or share the form as required.

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