Hazel Francis, Interim Risk Management and Patient Safety Program Administrator Tel: (850) 412-3747 Unit:(850) 412-3731 Fax: (850) 922-2217 Hazel.Francis@ahca.myflorida.com The Healthcare Agency administers serious injury notification, tracking, trending, and problem-solving programs in hospitals, ambulatory surgical centers, housing facilities, nursing homes, and certain HMOs in accordance with Florida statutes. The Agency may grant this reporting obligation to the Agency for one fortnight from the written justification of the installation administrator. The Agency may request a supplementary final report. Those reports shall not be made available to the public in accordance with the provisions. The Agency reviews each incident and determines whether it may be conduct of the health professional subject to disciplinary action, in this case the provisions of p. 456.073. 129Adverse incident reports must be sent to the Agency within 15 calendar days of the date of the incident, in accordance with section 153400.147, F.S. 155on Nursing Home Adverse Incident, AHCA Form 3110-0010 OL, April 2017, 166, resumed by reference and available at: 175https:/www.flrules.org/Gateway/reference.asp?No=Ref-08777, 177 and 178 through the Agency`s adverse reporting system Incidents that can only be accessed through the Agency`s Single Sign On portal at the following address: 199https:/apps.ahca.myflorida.com/SingleSignOnPortal200, may be submitted electronically to the Agency. 475(c) When the Agency`s Single Sign On Portal or Online Adverse Event Reporting System is temporarily out of service, the Licensee may contact the Agency directly at 1(888)419-3456 for support. . .

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Andrew Verboncouer • (920) 562-9601 • andrewverbs@gmail.com@averbs