AIR Report

Effective incident management is essential to assuring the health and welfare of KDADS program participants. The Adverse Incident Reporting (AIR) System focuses on the identification and follow-up to critical events or incidents that bring harm, or create the potential for harm, to a KDADS program participant. AIR focuses on critical events or incidents that the state itself deems as sufficiently serious to warrant near-term review and follow-up by an appropriate authority.

This Report DOES NOT replace a DCF or KDADS Long Term Care Complaint Hotline Report.

Notice

Hotline Phone Numbers and Information
Are you a Mandated Reporter?
The Report needs to be completed and submitted to KDADS prior to closing the window.
If you want to print/save a copy of this form, do so PRIOR TO submitting to KDADS. After submitting, the form will be reset.
If you need a copy of your form after you have closed the reporting screen, please call 800-432-3535, press 0 for the operator, and ask for the Program Integrity & Compliance Manager.
Quick Reference for Submitting AIR Reports
AIR Instructions for Reporters

Complete the Incident Information in the regions below and click the Create button at the bottom of the page. Once the report is created, a File Uploads region will display so that you can attach any document(s) related to this report.

Report Status: WORK IN PROGRESS Report Date: 12/03/2024

Purpose

Report Notification

Notice

Instructions 2

Report # Status & Date

AIR Contents

Incident Information

Reporter Details

Individual Details

Incident Details