This post has been archived and contains information that may be out of date.
The Centers for Medicare & Medicaid Services (CMS) has released a memorandum announcing that electronic Form CMS-10455, Report of a Hospital Death Associated with the Use of Restraint or Seclusion, has replaced the paper version of the form. As of Dec. 2, hospitals can submit the reports electronically online here.
CMS continues to accept paper forms through Dec. 31. Beginning Jan. 1, 2020, the agency will no longer accept paper versions of the form.
All types of hospitals are required to report patient deaths that occurred during or after restraint or seclusion was used, including psychiatric hospitals, rehabilitation hospitals, long-term care hospitals, acute care hospitals, and critical access hospitals with rehabilitation or psychiatric distinct-part units.
Instructional slides for completing and submitting the electronic form are included in the memorandum. Additionally, CMS has posted an instructional video on its surveyor training website.
Hospitals continue to be required by state regulations to also report these deaths as adverse events to the California Department of Public Health.
