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Title
Hospital Restraint/Seclusion Deaths to be Reported Using the Centers for Medicare and Medicaid Services (CMS) Form CMS-10455, Report of a Hospital Death Associated with Restraint or Seclusion
Memo #
14-27-Hospital-CAH/DPU
Posting Date
2014-05-09
Fiscal Year
2014
Summary
• Hospital Restraint/Seclusion Deaths to be Reported Using Form CMS-10455: Hospitals must use Form CMS-10455 to report those deaths associated with restraint and/or seclusion that are required by 42 CFR §482.13(g) to be reported directly to their Centers for Medicare & Medicaid Services (CMS) Regional Office (RO). This requirement also applies to rehabilitation or psychiatric distinct part units (DPUs) in Critical Access Hospitals (CAHs). • RO to Provide Submission Instructions: CMS ROs must provide hospitals with instructions for submitting the form to the RO by fax and/or e-mail, based on RO preference.
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