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Form DHCS5079 Unusual Incident / Injury / Death Report - California
What Is Form DHCS5079?
This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form DHCS5079?
A: Form DHCS5079 is the Unusual Incident/Injury/Death Report used in California.
Q: What is the purpose of Form DHCS5079?
A: The purpose of Form DHCS5079 is to report unusual incidents, injuries, or deaths that occur in California.
Q: Who needs to fill out Form DHCS5079?
A: Healthcare facilities in California are required to fill out Form DHCS5079 in the event of an unusual incident, injury, or death.
Q: What information is included in Form DHCS5079?
A: Form DHCS5079 includes details about the incident, including the date, time, location, individuals involved, and a description of what happened.
Q: Do I need to submit Form DHCS5079 electronically or by mail?
A: Form DHCS5079 can be submitted either electronically or by mail, depending on the instructions provided by the DHCS.
Q: Are there any deadlines for submitting Form DHCS5079?
A: The DHCS may have specific deadlines for submitting Form DHCS5079, so it is important to follow their instructions.
Q: What happens after I submit Form DHCS5079?
A: After submitting Form DHCS5079, the DHCS will review the report and may follow up with further investigations or actions as necessary.
Form Details:
- Released on September 1, 2015;
- The latest edition provided by the California Department of Health Care Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form DHCS5079 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
