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B. A. If facility operates under another name Finding Address Number Street City County State Zip Mailing Name of Director Page 1 of 3 ODH-912 Rev. 03/01 FOR DEPARTMENT USE ONLY Receipt License Issued Amount License Type Expires Date Changes Screening laboratories must provide the following Attach as an enclosure and number the response 5. Oklahoma State Department of Health PROTECTIVE HEALTH SERVICES Protective Health Services - 0505 Medical Facilities 1000 NE 10th Street Oklahoma City OK...
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What is odh 912 form?
The ODH 912 form is a document used for reporting certain information about a specific event or incident that occurred in a healthcare facility or provider.
Who is required to file odh 912 form?
Healthcare facilities or providers are required to file the ODH 912 form if they experience certain events or incidents that need to be reported to the Ohio Department of Health.
How to fill out odh 912 form?
To fill out the ODH 912 form, you need to provide detailed information about the incident or event, including the date, time, location, description, and any actions taken. The form should be filled out accurately and completely.
What is the purpose of odh 912 form?
The purpose of the ODH 912 form is to ensure that healthcare facilities or providers report any events or incidents that may have implications for patient safety or the quality of care provided.
What information must be reported on odh 912 form?
The ODH 912 form requires the reporting of specific information related to the incident or event, such as the type of event, the date and time it occurred, the details of any injuries or harm caused, and any corrective actions taken.
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