The authority has established an incident management system
for receipt, tracking and processing of complaints. Complaints may be reported
to the authority's incident management system using the authority website's
on-line form completion utility, by telephone using a toll free number,
facsimile, U.S. mail, email, or in-person. The method of reporting preferred by
the authority is on-line form completion via the authority's website,
http://dhi.health.state.nm.us/elibrary/ironline/ir.php. The toll free telephone
line is staffed by the authority during normal business hours and a message
system is available for reporting complaints during non-business hours.
A.
Incident report form.
Complaints of suspected abuse, neglect or exploitation will be reported by
providers on the department's incident report form if possible. This form and
instructions for completing and filing the form are available at the
department's website or may be obtained from the department by calling the toll
free number 800-752-8649 or 800-4456242 or by mailing a request to the incident
management bureau, division of health improvement, health care
authority.
B.
Reportable
intake information. Reports of suspected abuse, neglect or exploitation
made to the authority by persons who do not have access to, or are unable to
use, the authority's current incident report form shall provide as specific a
description of the incident or situation as possible, and shall contain the
following information where applicable:
(1)
the location, date and time or shift of the incident;
(2) the name, age and gender, address and
telephone number of the person the reporter suspects to have been abused,
neglected, or exploited, and the name, address and telephone number of the
guardian or health care decision maker for such person, if
applicable;
(3) the names,
addresses, phone numbers and other identifying information of the providers who
provide services to the person the reporter suspects to have been abused,
neglected, or exploited;
(4) the
names, addresses, phone numbers and other identifying information of the
following people who the reporter believes may have been involved with, or have
knowledge of, the incident; provider's staff and employees; family members or
guardians of the person the reporter suspects to have been abused, neglected,
or exploited; other health care professionals or facilities; and any other
persons who may have such knowledge;
(5) the condition and status of the person
the reporter suspects to have been abused, neglected, or exploited;
(6) the reporter's name, address, telephone
number and other contact information, together with the name and address of the
provider with whom the reporter is employed, if applicable.
C.
Method of filing
complaint. The completed incident report form must be filed with the
department. It may be hand delivered, mailed, emailed, or, preferably, filed by
use of the department's procedure for on-line form completion.
