How to Fill Out and Submit the Florida APD Incident Reporting Form

To report an incident involving a client with developmental disabilities in Florida, download the Florida APD Incident Reporting Form (OP 3-0006) from the Agency for Persons with Disabilities website, classify the event as either a critical incident or other reportable incident, complete both pages, and submit the form to the APD Regional Office that serves the county where the incident happened. Critical incidents require a phone call within one hour and the written form by the next business day; other reportable incidents require the written form within one business day.¹

Where to Download the Form

The current community-based version is form OP 3-0006, updated in December 2025, hosted on APD’s provider support page at apd.myflorida.com.² Licensed residential facilities may instead use the older form APD 10-002, which is referenced in the administrative code and available from your Regional Office.³ Both forms collect the same information; OP 3-0006 is the one for providers serving clients who live in the community rather than in a licensed facility. All entries on the form must be typed. Only signatures and initials may be handwritten.⁴

Which Incidents You Have to Report

APD sorts reportable events into two tiers. The tier controls your timeline and whether you have to call before sending paperwork.

Critical Incidents (One-Hour Phone Call)

Critical incidents require an immediate phone call, email, or in-person notification to the Regional Office. These are:⁴

Unexpected client death (not anticipated based on the client’s known medical condition)
Life-threatening injury
Sexual misconduct, including any sexual activity between staff and a client regardless of consent, nonconsensual contact between clients, or sexual activity involving a minor client
A missing minor client, or a missing adult client who has been adjudicated incompetent, whose whereabouts are unknown for more than one hour
Negative news coverage about the operation of a facility or the care of clients
Arrest of a provider staff member
Arrest of a client for a violent offense
A finding by the Department of Children and Families that abuse, neglect, exploitation, or abandonment by the provider or its employees has been verified

Other Reportable Incidents (One Business Day)

The second tier does not require a phone call, but you still owe the written form within one business day:⁴

A physical altercation between a client and another person
An involuntary psychiatric examination under the Baker Act
A client injury that is not life-threatening
Any unplanned emergency room visit or hospital admission
An expected client death (anticipated based on a known terminal condition)
A missing adult client who has not been adjudicated incompetent
A suicide attempt by a client
Arrest of a client for a non-violent offense

If you’re unsure which tier applies, treat the event as critical. Calling the Regional Office within one hour gets you guidance and keeps a late-filing problem off your record.

How Fast the Clock Runs

The clock starts the moment any staff member becomes aware of the incident, not when a supervisor is told or when paperwork begins.

For critical incidents, contact the Regional Office by phone, email, or in person within one hour of learning about the event. Every Regional Office staffs an on-call number around the clock. If the event occurs between 8:00 p.m. and 8:00 a.m., you may use judgment on whether to call immediately or wait until the next morning, but the oral report cannot be later than 9:00 a.m. Submit the completed written form by the next business day.⁴

For other reportable incidents, submit the written form within one business day by fax, email, or hand delivery. No phone call required.¹

A follow-up report is required for every incident, critical or reportable, within five business days of the initial filing.¹ Page two of the form, which documents follow-up measures, may be completed later than the initial filing but no more than 90 calendar days after it.⁴

Filling Out Page One

Page one captures what happened and who was involved. At the top, check the box for the specific incident type. The categories match the critical and reportable lists above. This classification determines how the Regional Office prioritizes review, so get it right.

Section 2 asks for identifying information on every person involved: full name, date of birth, iConnect ID (APD’s client data system identifier), and relationship to APD.² Verify the iConnect ID against the client’s record. A wrong number routes the report to the wrong file and delays review.

The narrative section is the core of the form. Describe the incident in chronological order: what happened first, what happened next, how the situation was resolved or stabilized. Stick to facts you directly observed or that were reported to you by people present. Leave out opinions, interpretations, and guesses about why something happened. State reviewers decide from this narrative whether an investigation is warranted, so vague or incomplete accounts slow the whole process.

Section 8 identifies the provider responsible for the client at the time of the incident, with facility or provider name, telephone, address, and email. Section 9 identifies the person actually filing the report, their role, their reviewing supervisor’s name and phone number, and the client’s Waiver Support Coordinator with contact information.² These two sections exist separately because the provider on duty when the incident occurred isn’t always the same entity as the one filing — a staffing agency employee might witness an incident at a host facility.

Filling Out Page Two

Page two documents what the provider did after the incident to protect the client and prevent recurrence. Immediate actions go here: calling 911, providing first aid, separating individuals in an altercation, arranging alternative placement. So do longer-term steps such as policy changes, additional staff training, or equipment modifications. You have up to 90 calendar days to complete this page, but filing it sooner builds a stronger compliance record if you’re audited.⁴

Where to Send the Completed Form

Every form goes to the APD Regional Office that serves the county where the incident occurred. Florida has six regions:⁵

Northwest: Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton, and Washington.
Northeast: Alachua, Baker, Bradford, Clay, Columbia, Dixie, Duval, Flagler, Gilchrist, Hamilton, Lafayette, Levy, Madison, Nassau, Putnam, St. Johns, Suwannee, Taylor, Union, and Volusia.
Central: Brevard, Citrus, Hardee, Hernando, Highlands, Lake, Marion, Orange, Osceola, Polk, Seminole, and Sumter.
Suncoast: Charlotte, Collier, DeSoto, Glades, Hendry, Hillsborough, Lee, Manatee, Pasco, Pinellas, and Sarasota.
Southeast: Broward, Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie.
Southern: Miami-Dade and Monroe.

Submit by fax, secure email, or personal delivery. Confirm receipt every time: get a fax confirmation page, an email read-receipt, or a signed acknowledgment on hand delivery. That confirmation is your proof of timely filing if a question comes up during an audit.³

The Abuse Hotline Is a Separate Call

Filing the APD form does not satisfy your duty to report suspected abuse, neglect, or exploitation. The two obligations are parallel. Anyone who knows or has reasonable cause to suspect that a person with a developmental disability is being abused, neglected, or exploited must call the Florida Abuse Hotline immediately at 1-800-962-2873.⁶

This duty runs to every staff member, not just supervisors. A direct service provider who witnesses an incident can and should call personally, and a provider agency cannot require employees to report internally before contacting the hotline. The direct worker should still notify a supervisor and the Regional Office so the incident report moves in parallel. Sexual assault and injury-causing physical altercations between two clients trigger the same dual duty: call the hotline, and report to APD.⁶

What Happens After You File

Regional Office staff review the report and decide whether a fact-finding investigation or additional follow-up is needed. Allegations of abuse, neglect, or exploitation are referred to the Department of Children and Families, which may open a separate investigation through the Florida Abuse Hotline system.⁷

Keep a copy of every submitted report in the client’s record. Florida Administrative Code 65G-2.009 requires client records to include incident reports that directly involve the client.⁸ A digital backup plus a physical copy is the safe approach, since APD may ask you to produce records on request.

If the Regional Office identifies a pattern of noncompliance or a serious rule violation, it may require a Corrective Action Plan within 10 days. The plan has to list each corrective action, the staff person responsible for it, and a completion deadline. APD will reject any plan that doesn’t address every identified violation, and the provider gets five business days to resubmit after a rejection. Missing the completion deadline, or repeating the same violation within 12 months, can lead to further enforcement.⁹

What Happens if You Don’t Report

APD treats failure to report known or suspected abuse, neglect, exploitation, or sexual misconduct as a serious compliance failure. Providers who don’t file face termination of Medicaid waiver enrollment, and APD will pursue both criminal and administrative penalties.¹ The agency can also impose a moratorium on new client assignments, levy an administrative fine, require a remediation plan, or terminate the Medicaid Waiver Services Agreement.¹⁰

Keeping the Form HIPAA-Compliant

The Incident Reporting Form contains names, dates of birth, medical details, and behavioral information that qualifies as protected health information. Covered entities, which include most APD providers who bill Medicaid electronically, must limit disclosures to the minimum necessary and transmit the form using secure methods.¹¹ When you email the form to a Regional Office, use encrypted email or a secure file-sharing method, not an unprotected attachment. Fax remains acceptable.

Store completed forms in a secured location: a locked cabinet for paper, an access-controlled folder for digital files. Limit access to staff with a legitimate need to review the incident. The HIPAA Security Rule requires technical safeguards including access controls, encryption, and authentication for electronically stored protected health information.¹¹

1
Agency for Persons with Disabilities – State of Florida. Incident Reporting
2
Florida Agency for Persons with Disabilities. APD Incident Reporting Form OP 3-0006
3
Agency for Persons with Disabilities – State of Florida. Revised Chapter 65G-2 Florida Administrative Code
4
Agency for Persons with Disabilities – State of Florida. APD Operating Procedure 3-0006 – Incident Reporting for Clients Living in the Community
5
Agency for Persons with Disabilities – State of Florida. Local Offices
6
Agency for Persons with Disabilities – State of Florida. Zero Tolerance Initiative – Reporting Abuse, Neglect and Exploitation
7
Florida Department of Children and Families. Florida Abuse Hotline
8
Legal Information Institute. Florida Administrative Code 65G-2.009 – Resident Care and Supervision Standards
9
Agency for Persons with Disabilities – State of Florida. Adopted Rules 65G-14 – Definitions, Corrective Action Plans, and Qualified Organizations
10
The 2025 Florida Statutes. Florida Statutes Chapter 393 – Developmental Disabilities
11
U.S. Department of Health and Human Services. Summary of the HIPAA Privacy Rule