New DDA Mortality Review Provider Form

Developmental Disabilities Administration Update

January 2, 2019

Dear Supported Living, Group Home and Group Training Home providers,

DSHS' Developmental Disabilities Administration updated the DDA Mortality Review Provider Report. The report must be completed when a client dies while receiving services, or within 30 days of transfer or admittance to a long-term care or medical facility. Some key changes include:

  • Submission to DDA Case Resource Manager within 7 days of death (versus 14)
  • Additions to Medical Information section
  • Attachments - must include all that are applicable:
    • IISP, Nursing Plan of Care, Treatment Plan, or Negotiated Care Plan

    • Care/progress notes from the previous seven days (prior to death or hospitalization)

    • Bowel program or protocol

    • Death certificate or worksheet
    • Seizure protocol

    • Specialized diet (if history of swallowing problems)

    • Client refusal of healthcare services

    • Results of any internal investigations related to death or care leading up to death

  • Signature requirement removed

Effective January 1, 2019, we will no longer accept the old Mortality Review Provider Report.

DDA Mortality Review Provider Report

Contact us for questions or feedback.