(b) The documentation for critical incidents shall contain, minimally:

1. (1) The facility name and name and signature of the person or persons reporting the incident;
2. (2) The name of the client or clients, staff person or persons, or others involved in the incident;
3. (3) The time, place, and date the incident occurred;
4. (4) The time and date the incident was reported and name of the person within the facility to whom it was reported;
5. (5) A description of the incident;

6. (6)

   1. (A) The severity of each injury, if applicable.
   2. (B) Severity shall be indicated as follows:

(i) No off-site medical care required or first-aid care administered onsite;

1. (ii) Medical care by a physician or nurse or follow-up attention required; or

   1. (iii) Hospitalization or immediate off-site medical attention was required; and

2. (7) Resolution or action taken, date action taken, and signature of the therapeutic community director.

   1. (c)
3. (1) The therapeutic community shall report those critical incidents to the Department of Human Services that include.
4. (2) Critical incidents involving allegations constituting a sentinel event or resident abuse shall be reported to the department immediately via telephone or fax, but not less than twenty-four (24) hours of the incident.

5. (3) If reported by telephone, the report shall be followed with a written report within twenty-four (24) hours.

   1. (d) The therapeutic community shall document and monitor internally, with a quality assurance and improvement process that will be made available for review and/or audit by an appropriate agency, the following: critical incidents requiring medical care by a physician or nurse or follow-up attention and incidents requiring hospitalization or immediate off-site medical attention.