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(Instructions and Privacy Act Notices on Reverse) DEPARTMENT OF HEALTH AND HUMAN SERVICESNOTICE OF ARRIVAL COMMISSIONED OFFICERSThis is not a travel reimbursement form. Form must be completed by all
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Form PHS-2874 is a notification form used by healthcare providers to report certain information related to patient health and safety matters.
Healthcare providers who are subject to specific reporting requirements under federal health regulations are required to file Form PHS-2874.
Form PHS-2874 should be filled out by providing accurate and complete information as specified in the form's instructions, including patient details and the nature of the reportable event.
The purpose of Form PHS-2874 is to ensure that healthcare providers comply with reporting obligations regarding patient safety and public health concerns.
The form must report information such as the provider's identifying details, the nature of the reportable event, patient information, and any relevant dates.
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