Mandatory Reporting

The purpose of mandatory reporting of potential violations is to protect the public. Conduct suspected of violating licensure regulations should be reported to the appropriate state regulatory agencies or departments for investigation.

Mandatory Reporting Form Templates

FSBPT created two customizable mandatory reporting form templates to serve as “samples” for jurisdictions to review and modify as applicable to their own state laws and regulations. These templates can be used to create reporting forms in your jurisdiction or to serve as a guide for additional items you may wish to add to your current forms.

• Template for Self Reporting
  For individuals to report violations related to their own practice or behaviors
• Template for Mandatory Reporting of another Licensee
  To report alleged violations of other health care providers

Duty to Report Trifold Brochure for Licensees

This brochure may be customized by your jurisdiction with your mission statement, name, address, and contact information and distributed to licensees.