Incident Reporting

1. Incident Reporting PM Form 7.4.1 - Required elements for complete and accurate Incident/Accident/Death (IAD) Reporting

2. What you will learn today: Submission expectations and timeframes Specific Gila River BHS submission requirements How to complete the updated PDF IAD form (Note: should a required box be incomplete, the form will stop the final email button from working until all data is entered; mandatory boxes shown in red in this presentation) What happens if the PDF IAD Report is incomplete, incorrect, or missing data What a Quality of Care concern Investigation is and what is required Note: Adobe 11 is required for the PDF IAD to function correctly (it is a free download). PDF incident/Accident/Death (IAD) Reporting

3. This is what the first page of the PDF IAD looks like. This page will be broken down by the 4 bracketed areas… INSTRUCTIONS MEMBER INFORMATION (2 parts) Diagnosis T/RBHA INFORMATION PDF IAD Reporting – Pg 1:

4. All sections of the IAD report must be completed; use N/A or ‘none’ where possible, but you may need to give your ‘best-guest’ for some dates as leaving them blank will block your attempts to email the PDF IAD to GRBHSQI. If the IAD is hand written it must be neat and legible (and signed by Preparer and Clinical Director), otherwise it may be returned for correction and resubmission. Gila River BHS requires a written report within 2 business days (48 hours) for all serious, critical, unusual incidents. Gila River BHS requests that verbal reports are made to the Gila River BHS Case Manager and the parent/guardian (for reports for a child or client with a guardian). In cases where there is no parent, the Tribal Social Services (TSS) Case Worker is the guardian and should be contacted. Please note, TSS and Gila River BHS are not affiliated; do not confuse the TSS Case Worker with the Gila River BHS Case Manager. This verbal report should be made within 1 business day of the incident (24 hours); voicemail is acceptable. PDF IAD Reporting – Pg 1: PDF IAD INSTRUCTIONS

5. Gila River BHS QI Department requests that all IAD Reports be submitted electronically as an attachment to a secure email as this is a HIPPA requirement. We provide Zixmail for this. You can access the secure email system by using the web address https://web1.zixmail.net/s/login?b=grhc and following instructions there. Sometimes a glitch in the system doesn’t allow this to work, so you can also find a previously protected email (from Gila River BHS), click on ‘Return’ or ‘Forward (then enter the GRBHSQI@grhc.org address)’ on an that protected email, delete previous attachments and documentation in the email body, readdressing the email, writing a new message in the body of the email and attach the new IAD Report. Faxing is a last resort; the fax number is given above, but please remember to call and report that an IAD has been faxed, by whom and which agency, so we know to look for it (sometimes we are out of toner, and all we get is blank pages, so the call is very important). PDF IAD Reporting – Pg 1: PDF IAD INSTRUCTIONS- Continued

6. MEMBER INFORMAITON • Member Name is the name of the person who the PDF IAD is being completed about. • Date of Birthis that person’s birth date (MM/DD/YYYY). • Age is the current age of that person. • Genderis selected by using the drop-down box provided… • *Please Note that all red boxes must be completed for PDF IAD to be accepted. You will not be able to submit the PDF IAD if it is not complete; you will be prompted to go back and complete the missing data.* PDF IAD Reporting– Pg 1: MEMBER INFORMATION

7. MEMBER INFORMAITON cont. • CIS ID #is a random 10-digit number (usually not the BHMIS ID #); the GRBHS Clinical Liaison should include this # with the Referral Packet. Contact them if you do not have it as you will need it for Billing and IAD Reporting. • AHCCCS ID is the 8 digit number that starts with an A. • Eligibility Status is selected by using the drop-down. • Category of BH fund is selected by using the drop-down. • History of COT at the time of the Incident (Court Ordered Treatment) is selected by using the drop-down. • DDD is selected by using the drop-down (GRBHS submissions are ‘No’). • CMDP is selected by using the drop-down (GRBHS submissions are ‘No’). PDF IAD Reporting– Pg 1: MEMBER INFORMATION

8. Diagnosis • There is space for multiple Diagnosis Codes and Names (based on DSM V nomenclature) for each PDF IAD. The first Diagnosis Code and Name are mandatory; other locations should only be used if more diagnoses exist for the member. • Diagnosis Codeis DSM Diagnosis # associated to the member’s diagnosis. • Diagnosis Name is the name of the DSM Diagnosis for the Code # identified. • Complete each Code/Name line as needed. PDF IAD Reporting– Pg 1: Diagnosis

9. T/RBHA INFORMATION • T/RBHA- please use the drop down box and select “Gila River Indian Community” for all individuals referred to you by Gila River BHS. • Assigned GSA is the number 4 for Gila River BHS. PDF IAD Reporting– Pg 1: T/RBHA INFORMATION

10. This is what the second page of the PDF IAD looks like. This page will be broken down by the 3 bracketed areas… PROVIDER INFORMATION INCIDENT INFORMATION Location of the Incident and Description of the Incident PDF IAD Reporting– Pg 2 :

11. PROVIDER INFORMAITON • Provider Name is your Agency name and not the name of the group home house. • License # is your location’s Behavioral Health license number. • Address is the Street, City, State and Zip Code of the specific site that is reporting the incident. • Phone # is the phone number of the agency or specific site that is reporting the incident. • Date of Last Visit With Clinical Team would be the date of the last contact with someone from Gila River BHS; a date must be used in this format: MM/DD/YYYY. • Date of Last Visit With the BHMP or PCP (psychiatrist or Primary Care Physician) would be the date of the last contact with one of these, or state ‘unknown.’ PDF IAD Reporting– Pg 2: PROVIDER INFORMATION

12. INCIDENT INFORMATION • Date of Incident is the actual date the incident being reported occurred (may be an approximate date or time of year. • Time of Incident is the time that the incident occurred (may be approximate time of day or mark ‘unknown’). • Date reported to the Provider- this is the date that the Incident was reported to the Provider. PDF IAD Reporting– Pg 2 : INCIDENT INFORMATION

13. INCIDENT INFORMATION cont. • Location of the Incident– please report as best you can where the incident being reported occurred using an address or description of where the incident occurred; at minimum have a county or area. • Description of the Incident- Completely, clearly and accurately, report all pertinent information related to the incident, including what led up to the incident. PDF IAD Reporting– Pg 2 : INCIDENT INFORMATION

14. This is what the third page of the PDF IAD looks like. This page will be broken down by the 6 bracketed areas regarding the Type of Incident… Mortalities-5 Serious/Critical Incidents-11 Member Rights Violations-10 Communicable Disease-1 HCAC/OPPC Incidents (Level I Hospitals only)-2 Other Serious/Critical Incidents-1 PDF IAD Reporting– Pg 3 :

15. INCIDENT INFORMATION cont. • Type of Incident • These first 5 Types of Incidents relate to the death of a person (Member). PDF IAD Reporting– Pg 3 : INCIDENT INFORMATION

16. INCIDENT INFORMATION cont. • Type of Incident cont. • These incident types are the critical/unusual Incident types that are required to be reported in writing, using the PDF IAD form. • - Note:AWOLs should be reported using this check-box (please do not indicate AWOL using the Other box, unless you Agency does not fit what is offered here). PDF IAD Reporting– Pg 3 : INCIDENT INFORMATION

17. INCIDENT INFORMATION cont. • Type of Incident cont. • These Types of Incidents are Member Rights Violations and are perpetrated by Adult/Staff members (person in authority) on clients, and not peer-to-peer. PDF IAD Reporting– Pg 3 : INCIDENT INFORMATION

18. INCIDENT INFORMATION cont. • Type of Incident cont. • Should a client, staff member or employee be found to have a communicable disease, there are also requirements beyond submitting a PDF IAD. The next slide contains a list of communicable diseases that should be reported to the T/RBHA, but there are other instructions regarding necessary reporting of communicable diseases. Please see bottom of the slide for more information. You will also receive a copy of this list for your use. PDF IAD Reporting– Pg 3 : INCIDENT INFORMATION

19. PDF IAD Reporting– Pg 3 : INCIDENT INFORMATION

20. Type of Incident cont. • These 2 incident types are for Level 1 Hospital settings and should they occur, be described in detail on page 3- Description of the Incident. • Examples of an HCAC would be: Foreign Object Retained After Surgery; Air Embolism; Blood Incompatibility; Stage III and IV Pressure Ulcers; Falls and Trauma; including Fractures, Dislocations, Intracranial Injuries; Crushing Injuries; Burns; Electric Shock; Catheter-Associated Urinary Tract Infection (UTI); Vascular Catheter-Associated Infection; Manifestations of Poor Glycemic Control (including: Diabetic Ketoacidosis, Nonketotic Hyperosmolar Coma, Hypoglycemic Coma); Secondary  Diabetes with Ketoacidosis, Secondary Diabetes with Hyperosmolarity; Surgical Site Infection Following: Coronary Artery Bypass Graft (CABG) – Mediastinitis; Bariatric Surgery; including Laparoscopic Gastric Bypass, Gastroenterostomy, Laparoscopic Gastric Restrictive Surgery; Orthopedic Procedures (including Spine, Neck, Shoulder, Elbow) • Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) Following Total Knee Replacement or Hip Replacement with pediatric and obstetric exceptions. PDF IAD Reporting– Pg 3 : INCIDENT INFORMATION

21. Type of Incident cont. • Examples of an OPPC would be: • Wrong Surgical or other invasive procedure performed on a patient • Surgical or other invasive procedure performed on the wrong body part • Surgical or other invasive procedure performed on the wrong patient PDF IAD Reporting– Pg 3 : INCIDENT INFORMATION

22. INCIDENT INFORMATION cont. • Type of Incident cont. • The Other line should be used to identify any other “serious, or critical” incident that do not fit into one of the previously provided categories. Be specific and brief here, and explain in more detail on page 3- Description of the Incident. Please refer to Definitions document. • There is no reason to report anything that is non-critical in writing (i.e.: nose bleeds, contraband, witness to something, minor property damage, etc.); you should call the Case Manager regarding these events and inform them, but no written report is needed. • If your program does not fit the ‘Unauthorized Absence…’ checkbox offered above, you should indicate ‘AWOL’ here. PDF IAD Reporting– Pg 3 : INCIDENT INFORMATION

23. This is what the forth page of the PDF IAD looks like. This page will be broken down into these 3 areas: Members Condition Before & After the Incident Individuals who Witnessed the Incident Description of any Medical Services Received PDF IAD Reporting– Pg 4:

24. Members Condition Before & After the Incident • Describe both of the following for Before and After the Incident: • Physical condition (defined as the condition or state of the body or bodily functions- rested, tired, agitated, tense, relaxed, etc.) and • Behavioral condition (document the client’s behaviors – yelling, pacing, making fists, shaking, hyper-vigilant, withdrawn, etc.) • Both of these conditions should be addressed, both before the incident and after the incident occurred. PDF IAD Reporting– Pg 4: Member’s Condition Before & After the Incident

25. Individuals who Witnessed the Incident • Please identify any witness to the incident and include the following information for each: • Witnesses Name; • Address (if known); • Phone # (if known); • and relation to the member for whom the PDF IAD is being completed. PDF IAD Reporting– Pg 4: Individuals who Witnessed the Incident

26. Description of any Medical Services Received • Please include the following information related to Medical Services supplied to the person (Member): • Date and time of Medical services; • Name of person who provided immediate attention; • Any sort of First-aid (from bandage to cold compress and beyond should trigger completion of this box; • If Urgent Care, ER or hospital is used, please indicate their name and attach their discharge paperwork (or write a summary of that document), if you have a copy, or submit when you receive it. PDF IAD Reporting– Pg 4: Description of any Medical Services Received

27. This is what the fifth page of the PDF IAD looks like. This page will be broken down into 4 areas: Actions Taken and/or Recommended NOTIFICATIONS PREPARER’S SIGNATURE Option buttons Paste new snipit here PDF IAD Reporting– Pg 5:

28. Actions Taken and/or Recommended • Please document the following: • Any Provider Agency actions taken related to the incident being reported (be specific regarding these because good documentation here could reduce the need for a Quality of Care (QOC) Investigation); • Recommendation of actions the Provider Agency will take to address this incident and to keep similar incidents from occurring in the future; • These Actions would include changes to Provider Agency policies or procedures; staff training, or other performance improvement activities (may be more appropriate in Clinical Director Review section). PDF IAD Reporting– Pg 5: Actions Taken and/or Recommended

29. Place new snipit here • NOTIFICATIONS • Agency • Please indicate which agencies were notified regarding this incident; please note the following: • Check T/RBHA for written report going to Gila River BHS QI (GRBHSQI@grhc.org) • Check Case Management/Assigned CPS/Provider to indicate calling the member’s GRBHS Case Manager within 24 hours to inform them of the incident; • Parent / Guardian/TSS Case Worker would be used to indicate phone calls to these; • Other (please indicate whom) would include any other agency or individual you have a signed Release of Information for, who has requested notification regarding incidents for the member. PDF IAD Reporting– Pg 5: NOTIFICATIONS

30. Place new snipit here • PREPARER’S SIGNATURE • Name & Credentials • Please include the name and credentials (Degree; position at the Provider Agency, AZ State License type, etc.) of the person completing the PDF IAD Report (and indicate you submitted electronically and that you will maintain a signed copy); • Date • Add the date that you affixed your signature to the document. • Signature (must be done prior to submission!) • Paste in and size a copy of your signature from a PDF document and make it fit in this area for signatures (sign a blank piece of paper, scan it back into your computer and save as a PDF document; click on your signature (a box should form around it; & copy it, and past it onto this page; move and size as needed to fit). You will need to significantly down-size it so that when pasted in it fits. See next slide. PDF IAD Reporting– Pg 5: Preparer’s Signature

31. PDF IAD Reporting– Pg 5: Preparer’s Signature

32. Place new snipit here • PREPARER’S SIGNATURE cont.(Yours should look like this.) • Signature • Following the instructions in last slide, paste in and size a copy of your signature from a word document or PDF document and make it fit in this area for signatures (sign a blank piece of paper, scan it back into your computer and save as a Word or PDF document; highlight it, copy it, and past it onto this page, moving and sizing it to fit • Date • Add the date that you affixed your signature to the document PDF IAD Reporting– Pg 5: Preparer’s Signature - Example

33. Options Buttons Spell Check- Checks the spelling on all written above and allows correction (click on button, then ‘Start’ and ‘Done’ when completed). Save Form- Saves the PDF IAD and what is written on it thus far. Please use the date and client’s initials in the label you assign the PDF IAD you save. Keep all PDF IADs in one location, so they are easy to find, should editing be needed. Email Form- NOTE: This button does not work on this page! Please follow this process: 1. Use the Save Form button to save the PDF IAD you have completed thus far (please use the date of the incident and client’s initials as part of this document's label); 2. Write an email to your Clinical Director/Designee and attach the PDF IAD you just saved to that email and ask them to complete the Clinical Director/Designee Review portion of the PDF IAD; 3. They should submit the completed PDF IAD using the Email Form button after their Signature box (submit to GRBHSQI@grhc.org.). Print Form- Allows you to print form with what was written (as the Preparer, do not print and sign, then scan back in, as Clinical Director Review editing will be turned off; just save and forward to your Clinical Director for their review and signature). PDF IAD Reporting– Pg 5: Emailing PDF IAD for Review

34. PDF IAD Reporting– Pg 5: Emailing PDF IAD for Review • DO NOT USE THIS ICON TO EMAIL EITHER, OR YOU WILL LOSE THE CONTENT OF THE PDF IAD YOU JUST COMPLETED AND SAVE A BLANK COPY. • Use the process described under “Email Form” in the last frame (33). • If you use the ‘File: Save As’ option, you will save the form, but lose anything typed in it; you must use the Save Form button after the signature line.

35. This is what the sixth page of the PDF IAD looks like. This page will be broken down into 5 areas: CLINICAL DIRECTOR REVIEW Date Reported to the T/RBHA Name & Credentials; Date; Signature Options Buttons T/RBHA REVIEW and Options Buttons PDF IAD Reporting– Pg 6:

36. CLINICAL DIRECTOR REVIEW • Review of Incident, Actions Taken and/or Recommended • Your Clinical Director or Designee will then review the incident, documentation, actions taken and/or recommended and document those here. Being specific regarding these could reduce the need for a Quality of Care (QOC) Investigation; • Document Recommendation of actions the Provider Agency will take to address this incident and to keep similar incidents from occurring in the future; • These Actions would include changes to Provider Agency policies or procedures; staff training, or other performance improvement activities. PDF IAD Reporting– Pg 6: Clinical Director Review

37. CLINICAL DIRECTOR REVIEW Cont. • Date Reported to the T/RBHA • This is where the date you emailed the PDF IAD to Gila River BHS (GRBHSQI@grhc.org) is entered. This date should be within 2 business days your finding out about the incident or the incident occurring. PDF IAD Reporting– Pg 6: Clinical Director Review

38. Place new snipit here • CLINICAL DIRECTOR REVIEW cont. • Name & Credentials • Please include the name and credentials (Degree; position at the Provider Agency, AZ State License type, etc.) of the person completing the PDF IAD Report (and indicate you submitted electronically and that you will maintain a signed copy); • Date • Add the date that you affixed your signature to the document. • Signature • Paste in and size a copy of your signature from a word document or PDF document and make it fit in this area for signatures (sign a blank piece of paper, scan it back into your computer and save as a Word or PDF document; highlight & copy it, and past it onto this page; move and size as needed to fit). See next slide. PDF IAD Reporting– Pg 6: Clinical Director Signature

39. PDF IAD Reporting– Pg 6: Clinical Director Signature

40. Place new snipit here • CLINICAL DIRECTOR REVIEW cont. (Yours should look like this.) • Signature* • Following the instructions in last slide to paste in and size a copy of your signature from a word document or PDF document and make it fit in this area for signatures (sign a blank piece of paper, scan it back into your computer and save as a Word or PDF document; highlight it, copy it, and past it onto this page, moving and sizing it to fit; • * - If you cannot figure this out, you will need to maintain a fully completed and signed copy of the PDF IAD at your agency; please let us know and we will offer you Technical Assistance as needed. • Date • Add the date that you affixed your signature to the document PDF IAD Reporting– Pg 6: Clinical Director Signature

41. CLINICAL DIRECTOR REVIEW cont. Options Buttons Spell Check- Checks the spelling on all written above and gives options and allows correction Save Form- Saves the PDF only and NOT what is written on it (find the email you attached it to and forward that email, edit the attached and send , if edits needed – YOU CANNOT SAVE A COMPLETED FORM AS A PDF, just the format (you will need to print or locate the email with the PDF IAD attached)! Email Form- (This button should work on this page!) To facilitate submission of the fully completed PDF IAD to Gila River BHS QI, the Clinical Director or Designee must click on the Email Form Button (be sure to save a copy of the fully completed PDF IAD first, so you have a complete PDF IAD form incase you have edits to make; send the email securely (use GRBHS-provided Zix Mail- see next slide) to GRBHSQI@grhc.org. (it seems to only work once) Print Form- Allows you to print the completed form with what was written (you could print and sign, but you will need to scan it back in as a PDF to submit; this would also limit your ability to edit the form, should it be needed: making you need to re-do the entire form to make corrections). PDF IAD Reporting– Pg 6: Emailing PDF IAD to GRBHSQI

42. Gila River BHS QI Department requests that all IAD Reports be submitted electronically as an attachment to a secure email as this is a HIPPA requirement. We provide Zixmail for this. You can access the secure email system by using the web address https://web1.zixmail.net/s/login?b=grhc and following instructions there. Sometimes a glitch in the system doesn’t allow this to work, so you can also find a previously protected email (from Gila River BHS), click on ‘Return’ or ‘Forward (then enter the GRBHSQI@grhc.org address)’ on an that protected email, delete previous attachments and documentation in the email body, readdressing the email, writing a new message in the body of the email and attach the new IAD Report. Faxing is a last resort; the fax number is given above, but please remember to call and report that an IAD has been faxed, by whom and which agency, so we know to look for it (sometimes we are out of toner, and all we get is blank pages, so the call is very important). PDF IAD EMAILING INSTRUCTIONS :

43. The Gila River BHS QI Department reviews every IAD submitted for completeness, accuracy and timeliness; any IAD that is incomplete or inaccurate is returned to the Provider Agency who submitted the report. Any returned report is expected to be corrected and resubmitted within 1 business day of it being returned (or 24 hours). This process will continue until the document is accurate and filled out completely. • Should Gila River BHS miss an incomplete or inaccurate IAD report and forward it to DBHS, DBHS may return the IAD to Gila River BHS and ask for correction and resubmission of the IAD. This request would be passed on to the Provider Agency, but the resubmission may need to occur before noon the following day, so Gila River BHS can meet its timeliness expectation. • Should Gila River BHS QI or DBHS see a negative trend regarding IAD submission from a Provider Agency (inaccurate, incomplete, submissions beyond the 48 hour/2 business day requirement) then Technical Assistance will be offered. Should the issue continue, Corrective Action will be requested and increased monitoring/review of IADs prior to submission by the Provider Agency will be expected as part of that. Incomplete, incorrect, or inaccurate IAD Reports- what happens?

44. T/RBHA REVIEW • Referred for Quality of Care (QOC) Investigation (FOR T/RBHA USE ONLY) • Each IAD sent to Gila River BHS is reviewed to see if more information is needed. The process for gaining this information is a Quality of Care (QOC) Investigation, which will be explained in its entirety later in this PowerPoint. By being as detailed as possible and opening Provider-driven investigations; reporting on your findings of those investigations and rationale for substantiating or unsubstantiating to GRBHSQI, enough information may be captured and shared to deem a separate QOC Investigation as unnecessary. • Options Buttons- for use by GRHBSQI only PDF IAD Reporting– Pg 6: T/RBHA REVIEW

45. Quick Review of Steps to Follow: Save a copy of the Gila River BHS PDF IAD as a blank form and use this form to write up all IAD Reports for Gila River BHS clients from that PDF IAD form; Complete the PDF IAD form Red boxes (at minimum); save and forward to your Clinical Director or Designee for final review, signature, and submission to Gila River BHS; Report verbally and submit written reports per specific Gila River BHS procedures (Instructions on the PDF IAD form); Make any requested corrections/edits and return the form within 1 business day of the request; The Provider should maintain a signed IAD, should they not be able to submit a signed IAD to Gila River BHS (GRBHSQI should be informed of this situation so Technical Assistance can be offered). PDF Incident/Accident/Death (IAD) Reporting

46. Questions? • If you are reviewing this IAD Reporting PowerPoint outside of a presentation and have questions, please email them to Don Arntsen at daarntsen@grhc.org. I will be happy to respond to your questions. PDF IAD Reporting

47. Quality of Care (QOC) Investigations All you need to know to participate in a QOC Investigations

48. AHCCCS mandated that all IADs submitted also be reviewed for any Quality of Care concerns (QOC); other concerns, complaints and other reports are also monitored for QOC-related issues. Should an issue be found the following will occur: QOC Investigation will be initiated by the Gila River BHS QI Department, (or at DBHS’ request); the specifics of the investigation and opening Level will be indicated in an email to those involved in the investigation; Any DBHS-initiated QOC will be acknowledged by Gila River BHS per DBHS-required procedures; Gila River BHS QI will send specific investigation-related questions to the Provider Agency or Agencies involved in the QOC Investigation (or others, as deemed appropriate to the investigation), with a specific due date for the requested information; a site visit by GRBHSQI may occur; Gila River BHS QI will review submissions and either request more information or send a closure letter for the QOC Investigation, indicating Level at closure; Gila River BHS QI will summarize the received information according to DBHS-required procedures and submit the findings for their review. All QOC Investigations will be closed within 30 days of initiation. Quality of Care concern Investigations

49. Gila River BHS QI will also initiate a QOC investigation for concerns, complaints or other issues that may arise. Should Gila River BHS QI initiate a QOC Investigation based on a complaint, etc., the following will occur: Just like the IAD-based QOC Investigation, Gila River BHS QI will initiate a QOC Investigation by sending an email, specifying what the investigation is about, investigation-related questions specific to the Provider Agency or Agencies involved in the QOC Investigation, opening Level of the QOC Investigation and a due date for Provider responses to the questions; Gila River BHS QI may send follow up questions to the Provider if more information is needed in the QOC Investigation (Please note that a DBHS contact is copied on these emails as well); These emails will be sent via Zixmail, so the Provider acknowledgement of receiving the QOC request (or subsequent questions) will be the Zixmail notification that comes to Gila River BHS QI when that email has been opened; Provider Agency responses are then summarized by Gila River BHS QI into a Summary Report and the findings are submitted to DBHS; Gila River BHS QI send a closure letter for the QOC Investigation, indicating Level at closure via email. All QOC Investigations will be closed within 30 days of initiation. Quality of Care concern Investigations

50. Please note that all QOC Investigations are strictly confidential. Should the Provider Agency have completed an internal investigation prior to or during the QOC Investigation, those findings may be requested as part of the QOC Investigation. Provider’s who submit summaries of their internal investigations may be asked for more specific information from their investigations related to an ongoing QOC Investigation, or to clarify the need for a QOC Investigation being initiated or not. Please comply with requests for information beyond your internal investigative summaries as the increased sharing of information can impact the need for a QOC Investigation. If the Provider performed an investigation of the incident in question and submits a follow up report, the Provider Summary Report should contain an explanation of what specifically was investigated, what your investigation found and if it was substantiated or unsubstantiated. Please be sure to present the rationale and supporting evidence for why that decision was reached. By doing so, you may greatly diminish your involvement in any QOC Investigation that occurs. Quality of Care concern Investigations