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Providers

Risk Management Incident Report


Use this form to report adverse incidents, including member injuries that occur during the delivery of covered services and incidents of suspected abuse, neglect and exploitation.

If you have questions regarding the form or need to update a previously submitted form, please contact Risk Management at riskmanagement@simplyhealthcareplans.com.

Please note: This tool does not have the ability to save entered data and retrieve it at a later date.

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