Kentucky Issues New Incident Forms

Long-Term Care Facility Self-Reported Incidents

The Centers for Medicare and Medicaid Services requires long-term care facilities to self-report incidents occurring in their facilities to the Office of Inspector General. For your convenience, fillable forms are available to promote continuity and consistency.

Two new Facility-Reported Incident forms have been released and are now posted HERE.

Please use the new forms effective immediately. Remember, if there is insufficient space to complete an answer, additional pages may be attached.

Questions may be directed to your respective OIG Division of Health Care Branch Office.