Staff only. This page is not behind a login. Use the secure form, and follow the agency’s occurrence-reporting policy. This website form does not replace a report to CDPHE when one is required.
Incident Report
For staff reporting an incident. This page is not a private intranet. The report itself belongs in the HIPAA form tool.
Secure form coming soon. Call us.
This form can include health information, a Medicaid ID, or a signature, so it is not sent through this website. Please call (720) 595-4418 or email care@sunshinehcss.com and we will help you complete it another way.
Draft for owner and legal review
The owner still needs to build this form in a HIPAA-ready tool and set HIPAA_FORM_INCIDENT_REPORT_URL. The field list is in FORMS.md. After the URL is set, redeploy so the security policy allows that form host.