Get Ny Opwdd 147 2016-2025

Filling out the NY OPWDD 147 form is an essential process for reporting incidents and occurrences related to individuals receiving services under the Office for People With Developmental Disabilities. This guide provides clear, step-by-step instructions to assist you in completing the form thoroughly and accurately.

Follow the steps to effectively fill out the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the 'Agency completing form' and 'Facility (if applicable)' sections. Ensure that the agency name is complete and accurate, as well as any facility information needed.
3. Fill in the 'Program type' and 'Address' fields with the relevant details related to the program offering services.
4. Provide the 'Phone' number for the agency, making sure it is a valid contact number.
5. Enter the 'Master incident number' and 'Agency incident number' if applicable, to track the incident accurately.
6. Respond to whether a related incident was previously reported by selecting 'Yes' or 'No'.
7. Document the name(s) of the person(s) receiving services, including their last and first names, followed by their date of birth and gender.
8. If applicable, include the TABS ID of the individual receiving services. Indicate if they receive medication by selecting 'Yes' or 'No'.
9. Record the 'Date and time incident was observed or discovered' by filling in the appropriate fields with month, day, year, and hour as required.
10. Input the number of persons receiving services present at the time of the incident and the number of employees present.
11. Select the preliminary classification of the incident by marking the appropriate checkbox for reportable incidents or notable occurrences.
12. Describe the specific location where the incident occurred. Choose from the provided options or specify if 'Other'.
13. In the section for a brief description of the incident, provide a detailed account. If necessary, continue on a separate sheet.
14. List all immediate corrective/protective actions that have been taken. This should include any medical treatment or counseling provided.
15. Complete the notification section as applicable, ensuring that law enforcement notifications are recorded if necessary.
16. Fill in the permanent residential address and phone number of the person listed previously if it is different than the provided agency address.
17. Choose the type of residence of the individual and print the name of the party completing the items. Include their title and date.
18. Record the name of the party reviewing the items and their title and date.
19. After completing all relevant sections, review the form for accuracy and completeness. Save changes, then download, print, or share the form as needed.

Complete your NY OPWDD 147 form online today to ensure proper reporting and follow-up on incidents and occurrences.