DOH Revises ACF Incident Report Again

The Department of Health (DOH) has issued a revised version of the Adult Care Facility Incident Report, DSS-3123. It should be noted that this form had been recently revised; this is an additional update. Changes to the form include reference to Justice Center reporting, an addendum for reporting a death or attempted suicide, and a quality assurance review. Click here to view the revised form, and here for the Dear Administrator letter which provides more important details. Questions about the form can be directed to DOH at 518-408-1133.

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828