How do I self-report an incident (DADS providers)

What is a self-reported incident?

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

Providers may be required to report other incidents according to their reporting guidelines or DADS rules. These include:

  • deaths,
  • misappropriation of funds,
  • drug diversions,
  • missing persons,
  • injuries of unknown source,
  • fires, or
  • situations that pose a threat to consumers, staff or the public. This includes when police or the local fire authority were notified or summoned to maintain safety.

How can a provider determine if an incident is reportable?

Reporting guidelines are available on the DADS website. Please click here to view all provider letters; they can be sorted by provider type. Or see the list of provider letters and regulatory requirements below.

DAD Provider Guidelines for Reporting Incidents
Provider Type Provider Letter # Regulatory Requirement
Adult day care facilities 2003-13
Assisted living facilities 2003-01
Licensed nursing facilities and skilled nursing facilities 2006-43
Licensed intermediate care facilities for persons with an intellectual disability (ICF/ID) 2010-24
Non-licensed ICF/IDs 2009-02
Home and community support service agencies (Home health and hospice) 2006-12

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How soon after an incident does a provider need to report it to DADS?

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

How can an incident be reported?

Two options are available to submit a provider self-reported incident:

  • You can submit an electronic self-reported incident via the DADS website.
  • You may make an oral report at 1-800-458-9858.

To make an electronic report

You can submit an electronic self-reported incident at www.dads.state.tx.us/services/crs/incidentforms/SRI/index.cfm.

Click here to read frequently asked questions regarding the Web-based Self-Entry Incident Reporting system.

To make an oral report

  1. Call 1-800-458-9858 regardless of the day or time.
  2. Select option 5 from the main menu.

You will be prompted to select a script from the menu which allows you to record details about the incident via a series of voice mail boxes.

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 anytime, press 9.

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.

DADS complaint intake specialists monitor the incident form application from 7 a.m. to 7 p.m. (Central time), Monday through Friday, (including holidays) and on weekends from 8 a.m. – 5 p.m. An intake specialist will call you to:

  • obtain additional information,
  • clarify details already reported and
  • give you the intake ID number of the incident. (Note: You will need this number to complete the Provider Investigation Report Form.)

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What information does a provider need to have available when reporting an incident?

Please click here to view the scripts that you will hear when you choose option 5. At a minimum, Complaint Intake needs the following information.

  • 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 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 of the consumer involved, age, date of birth and Social Security number. In addition, we need to know if he or she required special supervision, his or her level of cognition, pertinent medical history, and if he or she has 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.
  • What treatment was provided, and when and where treatment was provided.
  • The immediate action taken to protect consumers 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.

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How soon does a provider need to complete and submit their provider investigation report and where is the report sent?

This information is for nursing facilities, skilled nursing facilities, adult day care facilities, assisted living facilities and ICF/IID providers. Home health, hospice and personal assistance services providers, please click here for more information.

After submitting an electronic report via the web-based tracking system or after making an oral report to 1-800-458-9858, submit DADS Form 3613-A, Provider Investigation Report, with statements and other relevant documentation, within the applicable regulatory time frame:

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

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

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

If the report 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 E-249
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.

Do not fax and mail a report. Either fax the report and any attachments OR mail the report and any attachments, based on the length of the report.

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

Home and community support services agency (HCSSA) providers

After submitting an electronic report via the web-based tracking system or after making an oral report to 1-800-458-9858, 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.

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

If the report is16 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 E-249
PO Box 149030
Austin, TX 78714-9030

A report sent by mail must be postmarked by the 10th calendar day after the oral report.

Do not fax and mail the report. Either fax the report and any attachments OR mail the report and any attachments, based on the length of the report.

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

The DADS Regional Office may also contact HCSSA providers to request additional information.

Where can providers find the Provider Investigation Report Form?

The DADS forms catalog can be found by clicking here. Forms can be searched by keyword or number.

Or you can click on one of these links:

Can a provider submit a provider investigation report electronically?

At this time, DADS does not accept provider investigation reports electronically. 

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Updated: June 30, 2014