How to Report a Nursing Facility Incident
To report an incident, complete the Reportable Incident Form for Certified, Licensed or Registered Providers (PDF) and submit it to the Division of Licensing & Certification using one of the following options:
Option 1: Fax: (207) 287-9307 - Augusta District Office
Option 2: Mail:
- Division of Licensing and Certification
- 11 State House Station
- 41 Anthony Avenue
- Augusta Maine 04333
To promote consistency and save your staff some time, providers may want to pre-fill the form with the facility’s name, address, and other information that remains the same and save a copy of your pre-filled incident form for future use.
Alternatively, you may choose to report an incident online using the form below.
Option 3: You may choose to report an incident online.