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Welcome to the NC Incident Response Improvement System
DEVELOPMENT | PROVIDER PRACTICE/TRAINING SITE - DO NOT ENTER -REAL- INCIDENT REPORTS HERE!


Provider Incident Reporting

     Providers: You may enter only Level II and Level III incidents.





To view or Edit an existing Incident Report, enter the Incident Number and Consumer Name. If you do not have the Incident Number, please call your Tailored Plan and request that it be sent to you.

If you are unable to access the Incident Report form through this web site, notify your Tailored Plan's QA/QI office by phone. You are still responsible for reporting the incident and must complete a paper copy and deliver it to your Tailored Plan within the required timeline.

Links to Other State Agencies and Documents
 
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Agreement for Sharing of Patient Substance Use Disorder Information between Providers and NCDHHS ::
Under 42 CFR 2.53, providers are required, before submitting patient substance use disorder information from Part 2 programs (as defined in 42 CFR 2.11) into the Incident Response Improvement System, to obtain written agreement from the collecting state agency that the state agency agrees to specific conditions. The following message constitutes such written agreement by NCDHHS to address the sharing of this information through this Incident Response Improvement System.
  • DHHS agrees to the following: NCDHHS represents that it provides financial assistance to the program or other lawful holder and/or is authorized by law to regulate its activities;

  • NCDHHS requires the information for, and will use it only for, conducting an audit, conducting an evaluation, or (if a quality improvement organization) performing a utilization or quality control review;

  • NCDHHS will maintain and destroy the patient identifying information in a manner consistent with the policies and procedures established under ยง 2.16;

  • NCDHHS will retain records in compliance with applicable federal, state, and local record retention laws; and

  • NCDHHS will disclose patient identifying information only back to the program or other lawful holder from which it was obtained, or as required by law.



Version:  .Net 4.6 Created:  April 2010 Modified:  December 2018
IRIS Development