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Welcome to the NC Incident Response Improvement System
LIVE SITE - DO NOT ENTER -TEST- INCIDENT REPORTS HERE!

Provider Incident Reporting

     Providers: You may enter only Level II and Level III incidents.





To view or Edit an existing Incident Report, enter the Incident Number and Consumer Name. If you do not have the Incident Number, please call your LME and request that it be sent to you.

If you are unable to access the Incident Report form through this web site, notify your LME's QA/QI office by phone. You are still responsible for reporting the incident and must complete a paper copy and deliver it to your LME within the required timeline.

Links to Other State Agencies and Documents
 
LME / DHHS User Log-In

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to access the NC-IRIS application.
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Agreement for Sharing of Information between Providers and DHHS (including SU data):
According to 42 CFR 2.53, providers are required, before submitting the information into the Incident Response Improvement System, to obtain written agreement from the collecting state agency that the state agency agrees to specific conditions. The following message constitutes such written agreement by NC DHHS to address the sharing of information between these agencies.
  • DHHS agrees to the following: DHHS represents that it provides financial assistance to the program and/or is authorized by law to regulate its activities;

  • DHHS requires the information for, and will use it only for, conducting an audit, conducting an evaluation, or (if a quality improvement organization) performing a utilization or quality control review;

  • DHHS will maintain and destroy the patient identifying information in a manner consistent with the policies and procedures established under ยง 2.16;

  • DHHS will retain records in compliance with applicable federal, state, and local record retention laws; and

  • DHHS will disclose patient identifying information only back to the program from which it was obtained, or as required by law.



Version:  .NET 4.6 Created:  April 2010 Modified:  January 2019
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