Instructions:
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.
Tips:
Resources:
Laws: 105 §§ CMR 130.331 (b), 140.307 (b)
Facility Reporting to Department of Public Health
Contact Information
Department of Public Health, Bureau of Health Care Safety and Quality
Business hours:
617-753-8150
Non-business hours:
617-363-0755 or 617-469-1111
Fax: 617-753-8165
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.
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