Note: If the SRE occurred at another hospital or ambulatory surgery center, use this form to report by fax within 7 days, instead of electronically. You would not need to provide a 30-day follow-up report.
If the SRE involved any of the following*, call DPH and complete steps 2 and 3:
(See contact information below).
If not, skip this step and go to step 2
2. Within 7 days [of discovering the event]
Submit an initial report using the Virtual Gateway - Healthcare Facility Reporting System (HCFRS)
3. Within 30 days [of making the initial electronic report]
Submit a follow-up report through HCFRS that reflects the findings of your investigation of the event.
*This is a partial list of immediately reportable events. For the full list, see 105 CMR § 130.331(A) or § 140.307.
Not familiar with DPH’s online reporting system? You can get enrollment help, training materials, and more from DPH.
Remember that there are also specific requirements to notify patients and third-party payers about the event.
When filling your 30-day report be sure to include in your preventability determination narrative: identification and analysis of root causes; any updates to the incident narrative; and description of any corrective measures taken.
Laws: 105 §§ CMR 132.332, 140.308
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.