Provider Self-reporting of Incidents

Licensed or certified Texas Health and Human Services providers must notify the agency if someone in their care has been or may be physically or mentally abused, neglected or exploited.

Depending on their reporting guidelines and HHS rules, providers may be required to report other incidents including:

  • Deaths
  • Misappropriation of funds
  • Drug diversions
  • Missing persons
  • Injuries of unknown source
  • Fires
  • Situations that pose a threat to residents, employees or the public, including calling the police or the local fire authority to maintain safety

Self-reporting FAQs

How soon must an incident be reported?

Providers must make a report immediately upon learning of the incident, unless otherwise required by Regulatory Services reporting guidelines. See "Which incidents are reportable?" below for more information.

How do I report an incident?

You can report an incident online.

You can call 800-458-9858, regardless of the day or time; select option 2 from the main menu.

Where can I get help learning how to use the online report?

What happens when I call to make a report?

The following announcement plays when option 2 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 HHS provider, please continue.

To return to the beginning of this announcement at any time, press 9.

To speak with an intake specialist between the hours of 7 a.m. to 7 p.m. Monday through Friday, press 1.

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.

When can I report an incident?

Providers can make a report any time of day or night. HHS intake employees monitor the incident form application from 7 a.m. to 7 p.m. Central time, Monday through Friday.. On weekends and holidays, it is monitored from 8 a.m. to 5 p.m.

An intake specialist will call you to:

  • Obtain additional information
  • Clarify details
  • Give you the incident intake ID number which you will need to complete the Provider Investigation Report, HHS Form 3613 or 3613-A

What information do I need to report an incident?

You need to provide the following information in the initial report:

  • 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 the Texas Department of Family and Protective Services. 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, age, date of birth and Social Security number of the person about whom you are making the report. In addition, we need to know:
    • If special supervision was required
    • The person's level of cognition
    • The person's pertinent medical history
    • If there was 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.
  • Type of treatment provided, and when and where treatment was provided.
  • The immediate action taken to protect other people 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.

How soon must a facility complete a provider investigation report?

Note: The following applies to nursing facilities, skilled nursing facilities, day activity and health service providers, assisted living facilities, and intermediate care facilities.

After the electronic or phone report has been made, you must submit Form 3613-A, SNF, NF, ICF/IID, ALF, ADC, DAHS and PPECC Provider Investigation Report with Cover Sheet, with statements and other relevant documentation. A separate Form 3613-A must be completed and submitted for each incident reported.

The deadlines are:

  • Five working days for nursing facilities, skilled nursing facilities and licensed ICF/IIDs
  • Five calendar days for day activity and health service providers and assisted living facilities
  • Unlicensed ICF/IDs must submit a status report within five working days along with a copy of the DFPS final investigation report within 14 calendar days

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

Where do facilities submit the provider investigation report?

Either fax, mail or email the report and any attachments, based on the length of the report.

  • You may email the completed provider investigation report to ciicomplaints@hhsc.state.tx.us. (Attachments must be less than 20 MB.)
  • If Form 3613-A, with statements and other relevant documentation, is 15 pages or fewer, fax the report and attachments to 877-438-5827.
  • If Form 3613-A, with statements and other relevant documentation, is 16 pages or more, mail the report and attachments to:
    Texas Health and Human Services
    Complaint and Incident Intake
    Mail Code E249
    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.

How soon does a provider investigation report need to be completed by home and community support services agency?

After the electronic or phone report has been made, you must submit Form 3613, Provider Investigation Report with Fax Cover Sheet (Home Health, Hospice and Personal Assistance Services Provider Use Only), with statements and other relevant documentation no later than the 10th calendar day after reporting the alleged act to HHS.

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

Where do HCSSAs submit the report?

Either fax, mail, or email the report and any attachments, based on the length of the report.

  • You may email the completed provider investigation report to ciicomplaints@hhsc.state.tx.us. (Attachments must be less than 20 MB.)
  • If Form 3613, with statements and other relevant documentation, is 15 pages or fewer, fax the report and attachments to 1-877-438-5827.
  • If Form 3613, with statements and other relevant documentation, is 16 pages or more, mail the report and attachments to:
    Texas Health and Human Services
    Complaint and Incident Intake
    Mail Code E249
    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.

Where do I find the provider investigation report form?

The forms are available on the HHS website:

Form 3613-A, Provider Investigation Report with Cover Sheet (for use by skilled nursing facilities, nursing facilities, licensed ICFs, assisted living facilities and day activity and health service facilities)

Form 3613, Provider Investigation Report with Fax Cover Sheet (for use by home health, hospice and personal assistance service providers)

Can I submit the provider investigation report form online?

Provider reports can be sent via email to ciicomplaints@hhsc.state.tx.us.

Which incidents are reportable?