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Form CMS-10455 Report of a Hospital Death Associated With Restraint or Seclusion
What Is Form CMS-10455?
This is a legal form that was released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form CMS-10455?
A: Form CMS-10455 is a report that is used to document a hospital death associated with restraint or seclusion.
Q: Why is this form used?
A: This form is used to report any deaths that occur as a result of restraint or seclusion in a hospital setting.
Q: Who is required to complete this form?
A: Hospitals are required to complete this form if a death occurs that is associated with restraint or seclusion.
Q: What information is included in the form?
A: The form includes details about the patient, the circumstances surrounding their death, and any measures taken to prevent similar incidents in the future.
Form Details:
- The latest available edition released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form CMS-10455 by clicking the link below or browse more documents and templates provided by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services.
