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HOSPITAL RESTRAINT/SECLUSION DEATH REPORT WORKSHEET Revised July 2008A. Regional Office Contact Information RO Contacts Name×Date reported to CMS Regional OfficeTimeB. Provider Information *Hospital
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Regional office contact information includes the address, phone number, and email of the company's regional office.
All companies with regional offices are required to file regional office contact information.
Regional office contact information can be filled out online through the company's regulatory filing system.
The purpose of regional office contact information is to provide a point of contact for regulatory authorities and stakeholders.
The required information includes the office address, phone number, email, and the name of the regional manager.
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