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Death Reporting Forms

Woman at Computer Downloads Forms

Editable Death Reporting Form (PDF) 
Type this document on your computer, print it, and fax it to the Office of Ombudsman for Mental Health and Developmental Disability (OMHDD) at 651-797-1950 or 651-296-1021.

Death Reporting Form (PDF)
Print this document, write the information on the form, and fax it to the OMHDD at 651-797-1950 or 651-296-1021. 

Serious Injury Forms 

Editable Serious Injury Form (PDF) 
Type this document on your computer, print it, and fax it to the OMHDD at 651-797-1950 or 651-296-1021.

Serious Injury Form (PDF)  
Print this document, write the information on the form, and fax it to the OMHDD at 651-797-1950 or 651-296-1021.

Other Forms

Death or Serious Injury Report Fax Transmission Cover Sheet (PDF)  - Updated 2011
Use this fax cover sheet when you need to report a death or serious injury to the Department of Human Services (DHS), Office of Health Facility Complaints (OHFC) and/or the OMHDD. Fax it to the OMHDD at 651-797-1950 or 651-296-1021.

Notification Letter to Next-of-Kin (PDF) - Updated 2013

Procedures for Agency, Facility, and Provider Notification to Deceased Client's Next-of-Kin (PDF) - Updated 2013