Training Information

Training Name

Report of Hospital Death Associated With the Use of Restraint or Seclusion: Form CMS-10455 (RHDA_RS)

Activity Code


Training Description

This Form 10455 Training video intends to provide guidance on how to complete the electronic Form CMS-10455. The Form CMS-10455 is used to report to CMS all patient deaths associated with restraint or seclusion or both, in accordance with the requirements at 42 Code of Federal Regulations §482.13(g), Death Reporting Requirements. These requirements apply to all hospitals, including psychiatric hospitals, rehabilitation hospitals, long term care hospitals, short-term acute care hospitals, critical access hospital rehabilitation, and psychiatric distinct part units.

Click the link below to access Form CMS-10455.

Form CMS-10455

Video Duration: 20 minutes

Completion Requirements: After reviewing the Form 10455 Training video, the CMS-approved training evaluation must be completed to generate a certificate of completion.

Training CEUs: N/A

Email for Questions: The video is available on-demand online, 24 hours a day, 7 days a week. For all technical issues and those requiring an urgent response, such as accessing the video, email; for all content-related questions, email


No prerequisites in addition to those indicated in the Prerequisites (Mandatory) section of the Training Plan.

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