Section 458.351, Florida Statutes requires any adverse incident that occurs on or after January 1, 2000, in any office maintained by a physician for the practice of medicine which is not licensed under chapter 395 be reported to the department.
Adverse incidents must be reported within 15 days after the occurrence of the adverse incident.
To print an Adverse Incident Form online, click Forms under Resources located on this page.
Mail the completed Adverse Incident Form by certified mail to:
Department of Health
Consumer Services Unit
4052 Bald Cypress Way, Bin C75
Tallahassee, FL 32399-3275
For purposes of notification to the department, the term ”adverse incident” means an event over which the physician or licensee could exercise control and which is associated in whole or in part with a medical intervention, rather than the condition for which such intervention occurred, and which results in the following patient injuries:
(a) The death of a patient.
(b) Brain or spinal damage to a patient.
(c) The performance of a surgical procedure on the wrong patient.
(d) 1. The performance of a wrong-site surgical procedure;
2. The performance of a wrong surgical procedure; or
3. The surgical repair of damage to a patient resulting from a planned surgical procedure where the damage is not a recognized specific risk as disclosed to the patient and documented through the informed-consent process if it results in: death; brain or spinal damage; permanent disfigurement not to include the incision scar; fracture or dislocation of bones or joints; a limitation of neurological, physical, or sensory function; or any condition that required the transfer of the patient.
(e) A procedure to remove unplanned foreign objects remaining from a surgical procedure.
(f) Any condition that required the transfer of a patient to a hospital licensed under chapter 395 from an ambulatory surgical center licensed under chapter 395 or any facility or any office maintained by a physician for the practice of medicine which is not licensed under chapter 395.
Additional information regarding Adverse Incidents can be found at s. 458.351, F.S and Rule 64B8-9.001, FAC.