Download Forms

Death Reporting Forms

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

Serious Injury Forms

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

Other Forms

Death or Serious Injury Report Fax Transmission Cover Sheet PDF - 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.

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