Incident Reporting and Response Information
Incident Response Improvement System (IRIS)
IRIS is a web-based incident reporting and documentation system for Level II and III incidents involving consumers receiving services for mental health, substance abuse, and intellectual/developmental disabilities.
Category A providers (except hospitals) and Category B providers are required to report these incidents. Level II and III incidents must be entered and submitted in IRIS within 72 hours of a provider learning of the incident.
IRIS Practice Website
There is a Practice IRIS Website that can be used to train staff on how to enter incident reports in IRIS prior to going to the LIVE Iris website to enter real incidents. (Do NOT enter real incidents in the practice website.)
Level I Incidents and Level I Quarterly Provider Incident Report Form (QM11)
The state requires providers to document all Level I incidents and have documentation available onsite for regular reviews. Level I incidents are NOT to be entered into the IRIS web based reporting system.
Instead, submit a Level I Quarterly Provider Incident Report form (QM11) within 10 days of the end of the quarter. Please revise the SFY (State Fiscal Year) and Quarter on the report so that it is current.
Guilford County: Submit completed forms to the QM Department via email or fax to (336) 389-6127.
Other counties: Submit via email or fax to (336) 625-3661.
Page three of the form includes instructions if you are unclear who needs to submit or when.
Level II and III Incidents
All Level II and Level III incident reports must be entered and submitted electronically through IRIS online.
If IRIS is unavailable, providers must fax a copy of the incident report to the QM Department at (336) 625-3661 to meet the 72-hour reporting requirement. Blank incident report forms may be obtained here.
If you are unable to access the incident reporting forms on the website, please call (336) 389-6148 or (336) 389-6358. Providers are required to enter incident reports in IRIS as soon as possible once the IRIS system is available or the reporting issue has been resolved.
Level III incidents must be verbally reported within 24 hours of learning of the incident, or sooner if possible.
Internal Review (formerly “peer review”) for LEVEL III Incidents
All Category A and B providers (except ICF-MR’s) are required to conduct an internal review team (formerly “peer review”) review of level III incidents that occur when the consumer is receiving a service or if the incident occurred on the provider’s premises.
ICF-MR’s are required to abide by federal regulations to ensure client protection, investigate incidents and take appropriate corrective action. (CFR 483.420)
Requirements for conducting an internal review may be accessed in APSM 30-1, Rules for MH/DD/SA Facilities and Services, 27G.0603(c). A copy of this manual may be obtained here:
How to Request the IRIS Incident Report Number
Providers should print a copy of the IRIS incident report number when entering/submitting incident reports and maintain a copy of the number for future access.
If a provider is unable get the incident report number, the LME can request the number be sent to the provider’s email address. However, the provider should never share the IRIS incident report number with the LME or any other persons or agencies not authorized to have access to this confidential consumer information.
To request the IRIS Incident Report Number, Guilford County providers should call (336) 389-6148 and providers in all other counties should call 336-389-6358 and have the following information available:
- Name of the person entering the incident (exactly as entered)
- Consumer’s name (first name, last name and middle initial if used in your entry)
- Date of the incident
- Email to which you want the response sent. This email must have the same address (example: @yahoo.com) as the email entered in the incident report.
If the IRIS incident report number is unavailable, we will recommend that you re-enter the incident report in IRIS.
Please reference the Incident Response and Reporting Manual developed by the Department of Mental Health.
Incident Reporting Forms
- QM11 — Quarterly Provider Incident Report (must be submitted within 10 days of the end of the quarter).
- Restrictive Intervention and Details Report — See Client Rights Rules 27E.0401(e)(9) for details of required documentation.
- Blank copies of the Incident Reporting Form — Provider must meet the 72-hour reporting requirement even when IRIS is down or provider is having difficulty successfully submitting the report in IRIS.
- NC Innovations Incident Report for Back-Up Staffing Form
- HIPAA Confidentiality Incident Report Form — This incident report is completed anytime there is a HIPAA breach and must be forwarded to the Sandhills Center Privacy Officer for review and follow up. The Privacy Officer will review the incident and determine if a provider investigation is needed. Completed incident reports may be faxed or sent via secure email to Susan Campbell, Privacy Officer or by fax to (910) 673-1102.
- Providers may only SUBMIT and RESUBMIT under the Supervisor Actions Menu – Incident Submission Tab.
- You will get a “thumbs up” successfully submitted screen when the report is successfully submitted.
- Clicking on the “FINISHED MENU” DOES NOT SUBMIT THE REPORT.
- You must complete the first four menus in order to click on “FINISHED” to get an incident report number.
- The first four menus must be completed to get an incident report number prior to submitting the report. (Provider Information; Incident Information; Consumer/Treatments and Consumer/Services). Print a copy of the number for future use.
- IRIS Incident Report Numbers do not include the letter “O” (only zeros) or the letter “I” (only number 1).
- When RESUBMITTING a report under the Supervisor Actions Menu – Incident Submission Tab – DO NOT click on SAVE. This is the only time you do not save.
- Click on SUBMIT when you are RESUBMITTING and you will get a “thumbs up” successfully submitted screen when the report is successfully submitted.
Useful Online Resources:
Division of MH/DD/SA — http://www.ncdhhs.gov/mhddsas/
IRIS Technical Manual — http://www.ncdhhs.gov/document/iris-resources
Incident Response and Reporting Manual — http://www.ncdhhs.gov/document/iris-resources
Rules for MH/DD/SA Facilities and Services — http://www.ncdhhs.gov/apsm-30-01-rules-mental-health-developmental-disabilities-and-substance-abuse-facilities-and
Confidentiality Rules — http://www.ncdhhs.gov/apsm-45-1-confidentiality-rules
Record Management and Documentation Manual — https://www.ncdhhs.gov/divisions/mhddsas/reports/records-management-and-documentation-manual-rmdm
(QM11) Quarterly Provider Incident Report (must be submitted within 10 days of the end of the quarter for providers that did not request a wavier) — http://www.ncdhhs.gov/document/iris-resources
Restrictive Intervention and Details Report form – See Client Rights Rules 27E.0401(e)(9) for details of required documentation — http://www.ncdhhs.gov/document/incident-response-improvement-system-iris-forms
Provider must meet the 72 hour reporting requirement even when IRIS is down or provider is having difficulty successfully submitting the report in IRIS. A blank copy of the Incident Reporting Form can be printed from the following website address: http://www.ncdhhs.gov/document/incident-response-improvement-system-iris-forms