IN.gov - Skip Navigation

Note: This message is displayed if (1) your browser is not standards-compliant or (2) you have you disabled CSS. Read our Policies for more information.

Amber Alert
Amber Alert - TEST

Indiana State Department of Health

ISDH Home > Long Term Care > Incident Reporting by Long Term Care Facilities Incident Reporting by Long Term Care Facilities

Incident Reporting by a Nursing Home

This page is intended to provide comprehensive care and residential care facilities with information on the reporting of incidents to the Indiana State Department of Health (ISDH).  Except where otherwise stated, this page applies to:

  • Comprehensive care facilities (nursing homes)
  • Residential care facilities (licensed assisted living) 

This page is not intended for consumers for the submitting of complaints about a health care facility.  Consumers should go to the Reporting a complaint web page at www.in.gov/isdh/21533.htm for information on reporting a complaint. 

This page is also not intended for "covered individuals" for the Reporting a reasonable suspicion of a crime against a resident.  Providers should go to the Reporting a reasonable suspicion of a crime against a resident web page at www.in.gov/isdh/25766.htm for information. 

Contact the ISDH

Indiana State Department of Health
Division of Long Term Care
2 North Meridian Street, 4B
Indianapolis, IN 46204
(317) 233-7442 (Long Term Care Receptionist)
(317) 233-1325 (ISDH Main Switchboard)
Map

Complaint and Incident Reporting Program Director
Karen Smith
Email:  ksmith@isdh.in.gov
Phone: 317-233-7709
Fax: 317-233-7494

Director, Division of Long Term Care
Kim Rhoades
Email:  krhoades@isdh.in.gov
Phone:  (317) 233-7289
Phone:  (317) 233-9691 [Administrative Assistant]
Fax:  (317) 233-7322

Acronyms and Definitions

Acronyms

  • CMS:  Centers for Medicare and Medicaid Services
  • ISDH:  Indiana State Department of Health

Forms

Incident Report Form

The Incident report form is to be used by health care facilities for the reporting of reportable incidents.  This form may be used by all acute care and long term care facilities, centers, agencies, or clinics to notify the ISDH of a reportable incident.  The Incident report form is not to be used by covered individuals to report a reasonable suspicion of a crime against a long term care facility resident or by consumers to file a complaint.

How to Report an Incident to the ISDH

The following are ways to report reportable incidents, to include unusual occurrences or suspected crimes, to the ISDH: 

1.  Email the report to the ISDH

Email address for incident reports:  incidents@isdh.in.gov

2.  Fax the report to the ISDH

Fax number for incident reports:  (317) 233-7494

3.  Call the ISDH [not the preferred reporting method]

Complaint / Incident report line:  1-800-246-8909 [available during state business hours]
When calling the complaint / incident report line, you will be transferred to a nurse surveyor in the complaint / incident reporting program if there is an available surveyor.  If there is not a surveyor available to take the call, your call will go to the report line voicemail.
Complaint / Incident report line voicemail:  (317) 233-5359
If the complaint / incident report line is busy, you may call the voicemail line and leave the report on voicemail.

4. During non-state business hours, you may call the after-hours number (317) 233-8115.

If a follow-up report is needed, the facility must submit a written follow-up report by fax (317) 233-7494 or email (incidents@isdh.in.gov).

What Should be Included in the Incident Report

Regardless of the method of reporting, the following information should be included when reporting a reportable incident or suspected crime against a resident.  The Incident report form may be used for this purpose. 

  • Type of report (choose one): Initial / Follow-up / Initial with Follow-up
  • Facility name
  • Facility address
  • Facility city, state and zip
  • Person making the report and their title
  • Date and time of incident
  • Residents involved, room number, age and diagnosis
  • Staff involved, their title, and professional license or aide registry number
  • Brief description of incident
  • Type of injury/injuries
  • Immediate action taken
  • Preventative measures taken

Laws and Regulations

Comprehensive Care Facility (Nursing Home) Regulations

CMS Regulation:  42 CFR 483.13(c)(2) states:

The facility must ensure that all alleged violations involving mistreatment, neglect or abuse, including injuries of unknown source and misappropriation of resident property are reported immediately to the administrator of the facility and to other officials in accordance with State law through established procedures (including to the State Survey and Certification Agency).  [For procedures, see ISDH LTC Reportable Incidents Policy]

State Rule:  410 IAC 16.2-3.1-13(g)(1)

(g)   The responsibilities of the administrator shall include, but are not limited to, the following:
(1) Immediately informing the division by telephone, followed by written notice within twenty-four (24) hours, of unusual occurrences that directly threaten the welfare, safety, or health of the resident or residents, including, but not limited to, any:
(A) epidemic outbreaks;
(B) poisonings;
(C) fires; or
(D) major accidents.

Residential Care Facilities (licensed assisted living)

State Rule:  410 IAC 16.2-5-1.3 Administration and management

(g)  The administrator is responsible for the overall management of the facility. The responsibilities of the administrator shall include, but are not limited to, the following:
(1)  Informing the division within twenty-four (24) hours of becoming aware of an unusual occurrence that directly threatens the welfare, safety, or health of a resident. Notice of unusual occurrence may be made by telephone, followed by a written report, or by a written report only that is faxed or sent by electronic mail to the division within the twenty-four (24) hour time period. Unusual occurrences include, but are not limited to:
(A) epidemic outbreaks;
(B) poisonings;
(C) fires; or
(D) major accidents.

Program Guidance and Advisory Letters

ISDH Program Policies and Procedures

Page Last Updated:  February 18, 2013