Training Menu

Report of Hospital Death Associated With the Use of Restraint or Seclusion: Form CMS-10455 - Training Menu

Training for Hospitals and Critical Access Hospital Rehabilitation and/or Psychiatric Distinct Part Units reporting deaths associated with the use of restraint and/or seclusion to the CMS Regional Offices.

In accordance with the requirements at 42 CFR 482.13(g), Death Reporting Requirements, all patient deaths associated with restraint and/or seclusion (except 2-point soft wrist restraints that must be recorded in an internal hospital log or other system) are required to be reported to the Centers for Medicare and Medicaid Services Regional Offices using the Form CMS-10455, Report of a Hospital Death Associated with the Use of Restraint or Seclusion by all types of hospitals (including Psychiatric Hospitals, Rehabilitation Hospitals, Long Term Care Hospitals, Short Term Acute Care Hospitals) and Critical Access Hospital (CAH) Rehabilitation and/or Psychiatric Distinct Part Units (DPUs). This training will instruct how to complete the electronic Form CMS–10455.

Click the link below to access Form CMS-10455

Form CMS-10455

Associated Documents:

Training Menu:

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

Report of Hospital Death Associated with the Use of Restraint or Seclusion: Form CMS-10455 Slides

Scroll to top