Incidents Submission Portal for Long-Term Care Providers

Questions about incidents? Call the Complaint and Incident Intake hotline at 800-458-9858.

Texas Health and Human Services Commission has introduced a new incidents submission portal under Texas Unified Licensure Information Portal for the following licensed and/or certified Texas Health and Human Services providers to submit incidents online to notify the agency if someone in their care has been or may be physically or mentally abused, neglected or exploited:

Home and community support service agencies (home health and hospice)

Regulatory Requirements:

Day activity and health services

Regulatory Requirements:

Assisted living facilities

Regulatory Requirements:

Licensed Nursing Facilities and Skilled Nursing Facilities

Regulatory Requirements:

Intermediate Care Facilities for Persons with an Intellectual Disability

Regulatory Requirements:

Provider’s user guide to submit incidents online (PDF)

Frequently Asked Questions

How do I report an incident?

You can report an incident online at any time, day or night via the Texas Unified Licensure Information Portal (TULIP).

Long-term care providers will need a TULIP login to submit incidents online. There are several required fields which must be completed before you can submit your provider incident report. Links to continue to the next page or to go back to the previous page will be provided.

Narrative sections will have maximum character limits and the application will "timeout" after 30 minutes of inactivity if the application is open and the incident not successfully transmitted.

A confirmation number will be provided when the incident has been successfully transmitted. This number should be referenced on your Provider Investigation Report Form (applicable to long-term care providers only.)

Be sure to print a copy of the confirmation page for your records prior to submitting the online report.

NO additional contact from HHS intake staff will occur when you use the online application. HHS intake staff would only contact you if additional clarification or more details are needed regarding the incident to complete triage and prioritization of the intake.

In addition, providers can self-report an initial incident submission via email by filling out the CII Self-Report Email Template (PDF) and emailing it to CII Complaints or by speaking to a live agent during business hours (Monday-Friday 7 am-7 pm) at 1-800-458-9858.

What information do I need to report an incident?

You need to provide the following information:

  • Your name and title.
  • Primary and secondary phone numbers, including area code, where you can be reached.
  • The name and address of the provider on whose behalf you are making the report. Include license number or facility ID, if applicable.
  • Whether or not the incident was reported to the police, include the police report number. Please include the name of the employee who made the report.
  • The name, age, date of birth and Social Security number of the person about whom you are making the report. In addition, we need to know:
    • If special supervision was required
    • The person's level of cognition
    • The person's pertinent medical history
    • If there was a history of similar or prior incidents
  • The date and time you first learned of the incident and a brief narrative summary of the reportable incident. Please include the names of any alleged perpetrators or witnesses.
  • The date, time and results of any assessment conducted, including findings of injury or adverse effects noted.
  • Type of treatment provided, and when and where treatment was provided.
  • The immediate action taken to protect other people and to prevent occurrences of similar incidents.
  • The name(s) of anyone else you notified about the incident.
  • Other questions, specific to provider type, may be asked.

Where do long-term care providers submit the Provider Investigation Report, Form 3613-A/3613?

Long-term care providers can login to submit a Provider Investigation Report for incidents initially submitted online.

Provider Investigation Reports (Form 3613-A / Form 3613) for incidents submitted via phone call or email can be faxed, mailed or emailed along with any attachments, based on the length of the report.

  • You may email the completed provider investigation report to . (Attachments must be less than 20 MB.)
  • If the report with statements and other relevant documentation, is 15 pages or fewer, fax the report and attachments to 877-438-5827.
  • If the report, with statements and other relevant documentation, is 16 pages or more, mail the report and attachments to:
    Texas Health and Human Services
    Complaint and Incident Intake
    Mail Code E249
    P.O. Box 149030
    Austin, TX 78714-9030