Opioid Treatment Program (OTP) Death Reporting Form

This form is to be used by Opioid Treatment Programs (OTPs) to report the death of an individual enrolled in an OTP that did NOT occur on the premises of the licensed agency. According to WAC 246-341-1000, an agency providing Opioid Treatment Program (OTP) services must report the death of an individual enrolled in an OTP, within 48 hours.

Other critical incident reporting requirements for Behavioral Health Agencies (BHA), including OTP deaths that occurred on the premises of a licensed agency are directed by WAC 246-341-0420 and defined under WAC 246-341-0200 and are to be done using the Department of Health Complaint Intake Process.

Information collected via this survey may be subject to release in accordance with RCW 42.56 (Public Records Act). In the event of a request for these records, personally identifying information will be removed before any records are released.

Please contact us if you have any questions about this survey.