1. If the incident resulted in death, call DPH immediately and complete step 2 .
(See contact information)
If not, skip this step and go to step 2
2. Submit the form below by fax to 617-753-8165.
Laws: 105 §§ CMR 130.331 (b), 140.307 (b)
Fax Form (2012 ed.), (also available at the link below)
Department of Public Health, Bureau of Health Care Safety and Quality
617-363-0755 or 617-469-1111
We hope these instructions helped you meet this reporting requirement. Be aware that this action may not fulfill all applicable reporting requirements associated with the event.