Provider Self-reporting

Licensed or certified Texas Department of Aging and Disability Services (DADS) providers must notify the agency if someone in their care has been or may be physically or mentally abused, neglected or exploited.

Depending on their reporting guidelines and DADS rules, providers may be required to report other incidents including:

  • Deaths
  • Misappropriation of funds
  • Drug diversions
  • Missing persons
  • Injuries of unknown source
  • Fires
  • Situations that pose a threat to residents, employees or the public, including calling the police or the local fire authority to maintain safety

Self-reporting FAQs

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Providers must make a report immediately upon learning of the incident (unless otherwise required by Regulatory Services reporting guidelines).

  • You can report an incident online.
  • You can call 1-800-458-9858, regardless of the day or time; select option 5 from the main menu.

The following announcement plays when option 5 is selected from the main menu:

This option is not for the general public to report a complaint or request program information. Please re-dial and choose another option from the main menu. If you are reporting on behalf of a DADS provider, please continue.

To return to the beginning of this announcement at any time, press 9.

To speak with an intake specialist between the hours of 7 a.m. to 7 p.m. Monday through Friday, press 1.

Incident reporting guideline information is available on our website, www.dads.state.tx.us. On the home page, click 'Doing business with DADS,' then select 'Resources for DADS service providers,' choose a program service type from the menu on the left of the page and then, select 'Reporting incidents to Consumer Rights & Services' from the menu.

To repeat the menu options, press 9.

Once you select a script from the menu, you will begin to hear the incident form script. After each response, you will need to press the # key to move to the next query. It's important that you talk slowly and clearly and answer in complete sentences.

If information is not available at the time of the report or is not pertinent to the incident being reported, press the # key after the tone to move to the next query.

At the end of the script, you will be given an opportunity to provide additional information relevant to the incident report or to add to the information already recorded.

When you hang up, the report is submitted.

Providers can make a report any time of day or night. DADS intake employees monitor the incident form application from 7 a.m. to 7 p.m. Central time, Monday through Friday.. On weekends and holidays, it is monitored from 8 a.m. – 5 p.m.

An intake specialist will call you to:

  • Obtain additional information
  • Clarify details
  • Give you the incident intake ID number which you will need to complete the Provider Investigation Report, DADS Form 3613 or 3613-A

You need to provide the following information in the initial report:

  • Your name and title.
  • Primary and secondary phone numbers, including area code, where you can be reached.
  • The name of the facility, home health or hospice agency on whose behalf you are making the report. Please include the facility ID number or home health or hospice agency license number.
  • Whether or not the incident was reported to the police or the Texas Department of Family and Protective Services (DFPS). Please include the name of the employee who made the report and the DFPS call ID reference number or the police report number.
  • The name, age, date of birth and Social Security number of the person about whom you are making the report. In addition, we need to know:
    • If special supervision was required
    • The person’s level of cognition
    • The person’s pertinent medical history
    • If there was a history of similar or prior incidents
  • The date and time you first learned of the incident and a brief narrative summary of the reportable incident. Please include the names of any alleged perpetrators or witnesses.
  • The date, time and results of any assessment conducted, including findings of injury or adverse effects noted.
  • Type of treatment provided, and when and where treatment was provided.
  • The immediate action taken to protect other people and to prevent occurrences of similar incidents while you conduct and complete your investigation.
  • The name(s) of anyone else you notified about the incident.

Note: The following applies to nursing facilities, skilled nursing facilities, adult day care facilities, assisted living facilities and Intermediate care facilities (ICF/IIDs).

After the electronic or phone report has been made, you must submit DADS Form 3613-A, Provider Investigation Report, with statements and other relevant documentation. A separate Form 3613-A must be completed and submitted for each incident reported.

The deadlines are:

  • 5 working days for nursing facilities, skilled nursing facilities and licensed ICF/IIDs;
  • 5 calendar days for adult day care providers and assisted living facilities;
  • unlicensed ICF/IDs must submit a status report within 5 working days along with a copy of the Texas Department of Family and Protective Services (DFPS) final investigation report within 14 calendar days.

A "working day" is any 24-hour period, Monday through Friday, excluding state and federal holidays.

Either fax the report and any attachments OR mail the report and any attachments, based on the length of the report. You do not need to do both.

If the report is 15 pages or fewer
If Form 3613-A, with statements and other relevant documentation, is 15 pages or fewer, fax the report and attachments to 1-877-438-5827.

If the report is 16 pages or more
If Form 3613-A, with statements and other relevant documentation, is 16 pages or more, mail the report and attachments to:

Texas Department of Aging and Disability Services
Consumer Rights and Services — Complaint Intake Unit
Mail Code E249
P.O. Box 149030
Austin, TX 78714-9030

A report sent by mail must be postmarked by the regulatory due date after the oral report is made.

After the electronic or phone report has been made, you must submit DADS Form 3613, Provider Investigation Report, with statements and other relevant documentation no later than the 10th calendar day after reporting the alleged act to DADS.

A separate Form 3613 must be completed and submitted for each incident reported.

Either fax the report and any attachments OR mail the report and any attachments, based on the length of the report. You do not need to do both.

If the report is 15 pages or fewer
If Form 3613, with statements and other relevant documentation, is 15 pages or fewer, fax the report and attachments to 1-877-438-5827.

If the report is 16 pages or more
If Form 3613, with statements and other relevant documentation, is 16 pages or more, mail the report and attachments to:

Texas Department of Aging and Disability Services
Consumer Rights and Services — Complaint Intake Unit
Mail Code E249
P.O. Box 149030
Austin, TX 78714-9030

A report sent by mail must be postmarked by the regulatory due date after the oral report is made.

The forms are available on the DADS website:

Provider reports can be sent via email to CRSProvider@dads.state.tx.us.

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Updated: October 13, 2014