Reporting in Health Facilities

These guidelines describe the two different processes for reporting a complaint against a licensed healthcare facility regarding concerns or allegations of ANE, injuries of unknown origin, and death.

The two process for reporting are as follows:

1. Consumers, Family Members, and General Public
2. Health Facility Representatives

Licensed healthcare facilities include hospitals, nursing homes, assisted living facilities, home health agencies and hospice agencies, dialysis centers, ambulatory surgical centers, freestanding birth centers, diagnostic and treatment clinic, limited diagnostic and treatment clinic, community mental health centers and intermediate care facility for individuals with intellectual disabilities, rural health centers, outpatient physical therapy and speech pathology, and portable x-ray.

To report abuse, injuries of unknown origin, death or file a complaint, Choose the appropriate process to report for Consumers, Family Members, and General Public or Health Facility Representatives. It is important for you to identify with one of these types and follow the respective process.

NOTE: If you need to file a report against a home or community-based Medicaid waiver program, do not follow the instructions below. Instead, please visit our Reporting in Home & Community-Based Medicaid Waiver Programs page.

Instructions for Consumers, Family Members, and General Public

There are two different reporting methods available to consumers, family members, and the general public. You may report an incident either by calling our toll-free hotline, or by printing a paper form and then mailing or faxing it to us. Continue reading below for details on each method.

Call the Health Facility Complaints Hotline

1-800-752-8649

Print & Fax/Mail

Health Facility Consumer Complaint Form (Fax number and mailing address are in the form)

NOTE: If you are a health facility representative, do not follow these instructions. Instead, please see the Health Facility Representatives section below.

Instructions for Health Facility Representatives

Health facilities are required by the NMAC 7.1.13 to report all Incidents of Abuse, Neglect and exploitation, injuries of unknown origin and death where abuse or neglect may be suspected.

The preferred method for health facilities to report is to use the on-line reporting system. For health facility representative(s) who do not have access to the on-line reporting system they may report by printing a paper form and then mailing or faxing it to us. Continue reading below for details on each method.

Upon reporting an incident to DHI the health facility has five days to follow up with DHI with actions taken and conclusions reached, see the Follow-Up Process for details.

NOTE: If you are a consumer, family member, or general public, do not follow these instructions. Instead, please see the Consumers, Family Members, and General Public section above.

1. Online Reporting for Health Facilities

These instructions will guide you through using our Health Facility Reporting System in the most effective way possible.

1. Resident/Patient/Client Information — Complete as much demographic information as possible. Name, date of birth and or social security number is critical. If you do not have the Social Security Number then leave the field blank. The address is the physical address of the incident, not the address of the main corporate office.
2. Description of the Incident
   • Complete the allegation type.
   • Definitions of the incident type may be found in the regulations.
   • Complete the questions regarding responsibility and provider agency.
   • Complete the incident date and time.
   • Describe the incident: Give as much detailed information regarding before, during and after the incident.
   • Complete the bottom of this section and give a telephone number where you can be reached in the event that the case will be investigated.
3. Agency/Facility Information — Complete this section reporting the entire agency name and license number. Initials maybe confusing as two or more providers may have the same initials. If you are a unit of a larger facility, please put the name of the unit/wing/house.
4. Administrative Information — Name of Administrator and the Incident Coordinator and their contact information.
5. Notifications to Agencies — Document if you contacted the legal guardian or case manager and or other entities.

2. Follow-Up Process

Per the reporting regulations under NMAC 7.1.13.10, all licensed health care facilities shall conduct a complete investigation and report the actions taken and conclusions reached by the facility within five (5) days of discovery of the incident.

All health facilities must complete and submit a written Health Facility Complaint Investigation Five Day Follow-up Report Form to DHI Complaints Unit within 5 days from the date of the incident or the date of discovering the incident.

The brief narrative must include: a brief summary of the event, the conclusion of the event and what corrective actions were taken.

The 5 day follow up report can be sent by mail to DHI Complaints Unit, PO Box 26110, Santa Fe, NM 87505. Alternately, you may fax it to 888-576-0012 instead.