Florida Regulations 59A-4.123: Risk Management and Quality Assurance
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(1) The facility shall maintain a risk management and quality assurance committee as required in Florida Statutes § 400.147
(2) The facility shall use AHCA Form 3110-0009, Revised, January, 2002, October, 2001, “”Confidential Nursing Home Initial Adverse Incident Report – 1 Day,”” and AHCA Form 3110-0010, 3110-0010A, and 3110-0010B, Revised, January, 2002, “”Confidential Nursing Home Complete Adverse Incident Report – 15 Day,”” which are incorporated by reference when reporting events as stated in Florida Statutes § 400.147 These forms may be obtained from the Agency for Health Care Administration, Long Term Care Unit, 2727 Mahan Drive, MS #33, Tallahassee, FL 32308.
(3) Each facility shall use AHCA Form 3110-0008, Revised, October 2008, “”Nursing Home Monthly Liability Claim Information””, which are incorporated by reference when reporting liability claims filed against it as required by Florida Statutes § 400.147(9) These forms may be obtained from the Agency for Health Care Administration, Long Term Care Unit, 2727 Mahan Drive, MS #33, Tallahassee, FL 32308.
Rulemaking Authority 400.147, 400.23 FS. Law Implemented 400.022, 400.102, 400.141, 400.147, 400.23 FS. History-New 4-1-82, Amended 9-5-82, 4-1-84, 8-1-85, 7-10-91, Formerly 10D-29.123, Amended 4-18-94, 5-5-02.
(2) The facility shall use AHCA Form 3110-0009, Revised, January, 2002, October, 2001, “”Confidential Nursing Home Initial Adverse Incident Report – 1 Day,”” and AHCA Form 3110-0010, 3110-0010A, and 3110-0010B, Revised, January, 2002, “”Confidential Nursing Home Complete Adverse Incident Report – 15 Day,”” which are incorporated by reference when reporting events as stated in Florida Statutes § 400.147 These forms may be obtained from the Agency for Health Care Administration, Long Term Care Unit, 2727 Mahan Drive, MS #33, Tallahassee, FL 32308.
(3) Each facility shall use AHCA Form 3110-0008, Revised, October 2008, “”Nursing Home Monthly Liability Claim Information””, which are incorporated by reference when reporting liability claims filed against it as required by Florida Statutes § 400.147(9) These forms may be obtained from the Agency for Health Care Administration, Long Term Care Unit, 2727 Mahan Drive, MS #33, Tallahassee, FL 32308.
Rulemaking Authority 400.147, 400.23 FS. Law Implemented 400.022, 400.102, 400.141, 400.147, 400.23 FS. History-New 4-1-82, Amended 9-5-82, 4-1-84, 8-1-85, 7-10-91, Formerly 10D-29.123, Amended 4-18-94, 5-5-02.