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Form DHCS_5079 Unusual Incident / Injury / Death Report - California
What Is Form DHCS_5079?
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 DHCS_5079?
A: Form DHCS_5079 is the Unusual Incident/Injury/Death Report used in California.
Q: When should Form DHCS_5079 be used?
A: Form DHCS_5079 should be used to report any unusual incidents, injuries, or deaths in California.
Q: Who should use Form DHCS_5079?
A: Healthcare organizations, facilities, and providers in California should use Form DHCS_5079.
Q: What information is required on Form DHCS_5079?
A: Form DHCS_5079 requires information about the incident, including date, time, location, individuals involved, and a description of what occurred.
Q: Is Form DHCS_5079 confidential?
A: Yes, the information provided on Form DHCS_5079 is confidential and protected by privacy laws.
Q: What should be done after filling out Form DHCS_5079?
A: After filling out Form DHCS_5079, healthcare organizations should submit it to the appropriate regulatory agencies and retain a copy for their records.
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 DHCS_5079 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
