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CCSS Reportable Event Form

CCSS requires organizations to report all incidents that could result in a potentially compensable injury event (PCIE) including an elopement of any duration, a fall with injury, injury/illness, medication event, pressure ulcer, suicide, assault, unanticipated death or visitor event. Other events to report include requests for records, level F or higher deficiencies, family/resident complaints, demands for compensation, a Notice of Intent (NOI) or other statutorily required/jurisdictionally permitted “pre-suit” notice of potential claim.

Click Here to REPORT an Incident