Provider Type :
Reporting Agency :
Incident Report Form : Critical Incident Report


This website is for filing appropriate critical incident reports as required by the State of Indiana Division of Mental Health and Addiction.

Directions and definitions for the completion of a critical incident report may be found below:
Incident Webinar Trainings/Recordings:
NOTICE TO USERS: Please be advised, the Indiana Office of Technology (IOT) only supports Internet Explorer. If you access this site via Mozilla (Firefox), Safari, Chrome or some other agent, errors may occur. Thank you.
Contact:
Indiana Family and Social Services Administration
Division of Mental Health and Addition
402 West Washington Street W353
Indianapolis, IN 4604
Fax: 317-233-1986
Email: Dmha.IRC@fssa.IN.gov
© 2017 FSSA, State Of Indiana.
Links:
DMHA Website
DARMHA
Your IP : 3.219.167.194