Login
BHD INITIAL NOTICE OF INCIDENT
INCIDENTS MUST BE REPORTED IMMEDIATELY AFTER TAKING ACTIONS TO ADDRESS PERSON'S HEALTH AND SAFETY NEEDS.
Instruction: Please DO NOT use initials & abbreviations in narrative and for agency names. File a separate incident for each participant involved (except mass emergency), then please call the division immediately!
Participant Information
Client First Name
Client Middle Name
Client Last Name
Waiver
ABI
Support
Comp
Date of Incident
Location (City)
*OUT OF STATE
*STATEWIDE
ACME
AFTON
ALADDIN
ALBANY
ALBIN
ALCOVA
ALPINE
ALTA
ALVA
ARAPAHOE
ARLINGTON
ARMINTO
ARVADA
ATLANTIC CITY
AUBURN
BAGGS
BAIROIL
BANNER
BAR NUNN
BASIN
BEAR RIVER
BECKTON
BEDFORD
BEULAH
BIG HORN
BIG PINEY
BIG SANDY
BIG TRAILS
BILL
BITTER CREEK
BONDURANT
BORDER
BOSIER
BOSLER
BOULDER
BOXELDER
BRIDGER
BUCKHORN
BUFFALO
BUFORD
BURGESS JCT
BURGESS JCT.
BURLINGTON
BURNS
BURNTFORK
BURRIS
BYRON
CALPET
CANYON
CARLILE
CARPENTER
CARTER
CASPER
CENTENNIAL
CHEYENNE
CHUGWATER
CLARETON
CLARK
CLEARMONT
CODY
COKEVILLE
COLONY
CORA
COWLEY
CRESTON JCT
CROWHEART
DANIEL
DAYTON
DEAVER
DEVILS TOWER JCT
DEVILS TOWER JCT.
DIAMONDVILLE
DIXON
DOUGLAS
DUBOIS
E. THERMOPOLIS
EDEN
EDGERTON
EGBERT
ELK BASIN
ELK MOUNTAIN
ELKOL
ELMO
EMBLEM
ENCAMPMENT
ERVAY
ESTERBROOK
ETHETE
ETNA
EVANSTON
EVANSVILLE
FAIRVIEW
FARSON
FEDERAL
FORT BRIDGER
FORT LARAMIE
FORT WASHAKIE
FOUR CORNERS
FOX PARK
FRANNIE
FREEDOM
FRONTIER
GARLAND
GILLETTE
GLENDO
GLENROCK
GRANGER
GRANITE CANYON
GRASS CREEK
GREEN RIVER
GREYBULL
GROVER
GUERNSEY
HAMILTON DOME
HAMPSHIRE
HANNA
HARMONY
HARRIMAN
HARTVILLE
HAWK SPRINGS
HILAND
HILLSDALE
HOBACK JCT
HOBACK JCT.
HOBACK JUNCTION
HORSE CREEK
HUDSON
HULETT
HUNTLEY
HYATTVILLE
IRON MOUNTAIN
JACKSON
JAMESTOWN
JAY EM
JEFFREY CITY
JELM
JENNY LAKE
KAYCEE
KEELINE
KELLY
KEMMERER
KINNEAR
KIRBY
LA BARGE
LA GRANGE
LAGRANGE
LAKE
LAMONT
LANCE CREEK
LANDER
LARAMIE
LEITER
LIGHTNING FLAT
LINCH
LINGLE
LITTLE AMERICA
LONETREE
LOST CABIN
LOST SPRINGS
LOVELL
LUCERNE
LUSK
LYMAN
LYSITE
MADISON JCT
MAMMOTH SPRINGS JCT
MANDERSON
MANVILLE
MARBLETON
MAYOWORTH
MCFADDEN
MCKINNON
MEDICINE BOW
MEETEETSE
MERIDAN
MERNA
MIDWEST
MILLBURNE
MILLS
MONETA
MOORCROFT
MOOSE
MORAN
MORAN JCT
MORRISEY
MORTON
MOSKEE
MOUNTAIN HOME
MOUNTAIN VIEW
MULE CR JCT
NATRONA
NEW HAVEN
NEWCASTLE
NODE
NORRIS JCT
OLD FAITHFUL
OPAL
ORIN
ORPHA
OSAGE
OSHOTO
OSMOND
OTTO
PARKMAN
PAVILLION
PIEDMONT
PINE BLUFFS
PINE HAVEN
PINE TREE JCT
PINEDALE
PITCHFORK
POINT OF ROCKS
POWDER RIVER
POWELL
PRAIRIE CENTER
QUEALY
RALSTON
RANCHESTER
RAWLINS
RECLUSE
RED DESERT
REDBIRD
RELIANCE
RENO JCT
RIVERSIDE
RIVERTON
ROBERTSON
ROCK RIVER
ROCK SPRINGS
ROCKYPOINT
ROLLING HILLS
ROZET
SAGE
SARATOGA
SAVAGETON
SAVERY
SHAWNEE
SHELL
SHERIDAN
SHOSHONI
SINCLAIR
SLATER
SMOOT
SOUTH AFTON
SOUTH PASS CITY
SPOTTED HORSE
ST. STEPHENS
STAR VALLEY RANCH
STORY
SUNDANCE
SUNRISE
SUPERIOR
SUSSEX
TABLE ROCK
TEN SLEEP
TETON
TETON VILLAGE
THAYNE
THERMOPOLIS
TIE SIDING
TORRINGTON
TOWER JCT
TURNERVILLE
UCROSS
UPTON
URIE
VALLEY
VAN TASSELL
VETERAN
W. THUMB JCT
WALCOTT
WALTMAN
WAMSUTTER
WAPITI
WASHAM
WENDOVER
WESTON
WHEATLAND
WILSON
WOODS LANDING
WORLAND
WRIGHT
YODER
Date of Report
Person Reporting
Phone
Email
Title or Relation To The Client
Provider Information
Service
S5100-ADS BASIC
S5102 Adult Day Basic Daily
S5108-ADS HGH
S5100TG-ADSHigh
S5105 Adult Day High Daily
S5100UA ADS I
S5102UA Adult Day Intermediate Daily
T2025-Behavioral Support
97152 - Behavioral Support Services - BCaBA Level
97151 - Behavioral Support Services - BCBA Level
97153 - Behavioral Support Services - RBT Level
T2022-Case Management
T2027HA-Child Habilitation Service (0-12)
T2027-Child Habilitation Service (13-18)
H2014-Cognitive Retraining
T2017UN - Community Living Services Group 2 (FKA: Supported Living Basic Group 2)
T2017UP - Community Living Services Group 3 (FKA: Supported Living Group of 3)
T2031 - Community Living Services Group up to 3 Daily (FKA: Supported Living Basic Up to 3)
T2016UD - Community Living Services Host Home
T2017 - Community Living Services Individual (FKA:Supported Living Basic)
T2016 - Community Living Services Level 3 (FKA: Res Hab LVL3)
T2016U7 - Community Living Services Level 4 (FKA: Res Hab LVL4)
T2016U6 - Community Living Services Level 5 (FKA: Res Hab LVL5)
T2016U5 - Community Living Services Level 6 (FKA: Res Hab LVL 6)
T2021 - Community Support Services (FKA: Community Integration Basic)
T2020 - Community Support Services Daily (FKA Community Integration Basic Daily)
T2021HB - Community Support Services High (FKA: Community Integration High)
T2020HB - Community Support Services High Daily (FKA: Community Integration High Daily)
T2021U1 - Community Support Services Intermediate (FKA: Community Integration Intermediate)
T2020U1 - Community Support Services Intermediate Daily (FKA: Community Integration Intermediate Daily)
S5135TT CG3
S5135-Companion Services
S5136-Companion Services (Group)
S5135HQ-Companion Services (Group)
H2011 CRISIS INT
S9470-Dietician
H2025-Empl Discov
S5165-Environmental Modifications
T2029NU-Specialized Equipment
T2029-Specialized Equipment Repair
S5130-Homemaker
S5165NU-EnviroModifications
T2038 - Individual Habilitation Training
97532 OT
T1019-Personal Care
97110-Physical Therapy
T2015TF-Prevoc Inermdt LOC
T2015HJ PREV H
T2015TG-PREVOC HIGH
T2015U2 PREV INT
97150-PT/OT GROUP
T1005-Respite Care
S5151HQ Respite Group /Daily unit
T1005HQ Respite Group 15 minute unit
S5151 Respite Individual/Daily unit
T1002-Skilled Nursing
T1001 - Skilled Nursing Assessment
T2033-Special Family Habilitation Home
92507-Speech Therapy Individ
92508-Speech Therap. GRP
T2019U8 SE INDIV
T2019TS-SEFA
T2019UQ-Supported Employment Grp
T2019-Supported Employ Individual
T2023-Targeted Case Management
T2003-TRANSP
T2001 - Transportation - per 10 Mile Trip
A0090 - Transportation - per 5 Mile Trip
If other, please specify:
Organization
A Better Life, Inc.
A+ COMMUNITY SERVICES
AAA Angela Thomas
AAI SERVICES
ABI WINTERHAWK RECOVERY LLC
ABILITIES AND BEYOND
ABILITIES PLUS
Able Hands
ABLED MINDS
Above & Beyond Care, LLC
ABRAHAMSON, LYNDA
ACCEPTANCE AND ABILITY FOCUSED SERVICES AND SUPPORTS
ACCESS ACCOUNTABLE CASE MANAGEMENT, LLC
ACES$
ACHIEVING GREATNESS LLC
ACM
ADVANCING ABILITIES
Advantage Community Supports, LLC
AFII LLC
ALEXANDER, REBECCA
ALIGN SERVICES LLC
ALL ABOUT FAMILY
All Children Matter LLC
ALL FOR YOU LLC
All in Andilyn Time, LLC
ALLIANCE FOR SELF DETERMINATION, INC
ALLIES IN ADVOCACY
Aloha Caring Hands of Wyoming
AltaMeta Enterprises
ALTERNATE PATHWAY
Always at Home LLC
Amanda Pomeroy
Ambrit Care LLC
AMOS, JENNIFER
ANDREWS, JOLYNN
APODACA, CONNIE
April Constantine
ARC OF NATRONA COUNTY, THE
ARCHER, CHERYL
ARK REGIONAL SERVICES
ASAY, JAMIE
ASPIRE CASE MANAGEMENT
Aspire Nursing
ASPIRING CHANGE LLC
Awesome Abilities Enhanced, LLC
B.A.C.A.
BANGS, DANIELLE
BARRETT, JANET
BARTELS-GREENLEE, MARY
BASILE, PAMELA
Be the Change, LLC
BEATTY, TIFFANI
BELIEVE & CONQUER LLC
BELIEVE, LLC
Bennett Case Management, LLC
BENNETT, KRISTIE
Berg, Stefanie
Bessie M. Holdsworth
BEST HOME HEALTH
BEST, EMMA
BIG HORN ENTERPRISES, INC.
Bingaman, Andrew
BLESI (PEPPLE), DENISE
BLESI, TAMARA
Blessed Abilities
Blue Skies Provider Services
BLUEMEL, CHARLYN R.
BOHN, LINDA
Borcher, Jessi
BOUCHARD, JULIE
BOWEN, TERESA
Bower, Jessie Lynn
BOWER, PAM
BOWMAN, LOIS LAVAUGHN
BOYER, AMY
BOYLES, PENNY
BRAIN INJURY ALLIANCE OF WYOMING
BREAZEALE, JANET
Brenda S Dockery
BRIDGES OF WYOMING
BRITT, DELAINE
BRITTAIN, JUDY
Brooke Elardi
Brooke Lehto
BROWN, MELODI
BRUNE, JULIE
BRUSH, KELLY
BRUSKI, KAM
BUDIG, PATRICIA
BUDIG, SHERWOOD
BUECHLER, CHRISTIAN
BUI, LISHA
BURDEN, TONISHA
BUTSCH BERRIAN, GILLIAN
BYBEE ENTERPRISES, LLC
CABANAG, COURTNEY
CALDWELL, ASHLEY
CALL, AARON
CAMPBELL MELISSA JO
CAMPBELL, JESSICA
CANNON, SANDRA
CARE PARTNERS OF WYOMING INC.
CARE WY LLC
CARING HEARTS CASE MANAGEMENT
Caring Tender Hearts
Carl Dube
Cascabel Investments
CASE MANAGEMENT FOR POSITIVE SOLUTIONS
CASE MANAGEMENT SERVICES OF WYOMING
CASTRO, JOE
CATES, KAMI
CB CASE MANAGEMENT, LLC
CELLMER, MAUREEN
CENTRUM FOR DISABILITY SERVICES
Chantall Cherry
Charla Ricciardi
Charlene Peterson
CHARLES, ELLIS TIMOTHY
CHAVEZ, BERTHA
CHEATHAM, PEGGY R.
Chelsea Davis
CHESTNUTT, MICHAEL
Cheyenne Hab & Therapeutic Center
CHEYENNE REGIONAL MEDICAL CENTER-HOME CARE SVCS
CHICO, JESSICA
Child Development Center of Natrona County
CHOICES AND CHANGES LLC
CHRISTIE, AMY
CIRCLE C RESOURCES
Circle Circle Dot Dot LLC
CLARK, BARBARA
CMS, INC.
COLE, PAULA
COMMUNITY ENTRY SERVICES
Compassionate Home Care LTD
CONNECTAMERICA.COM LLC
CONNECTIONS OF THE HEART LLC
Connie B Barton
CONRAD, LORIE
Constant Companion LLC
COOK, KANDI
COONIS, JAMES
COOPER, JULIE
COOPER, KIMBERLY A.
COOPER, NICOLE
COOPER, SHAWNDRA
COPENHAVER, TIERNEY
CORBIN, KIMBERLEY
CORDOVA, CINDY
CORNEJO, DESIRAE
Cottonwood Homes, LLC
Count Abilities Case Management
Courtney Judd
COURTNEY, MARK
COWBOY CARES, INC
CRECELIUS, SANDRA
CRIPPEN, TRICIA
CROCKETT, MARY
CROFT ESTAY, CAROLINE
CROSBY, SYLVIA
CROWDER, KENNETH
CROWDER, SHIRLEY
Currah, Arian
Cynthia J.Weed
DALLMAN, CAILYN
DANCE, CINDY
Davis Home Health dba Healing Hearts Home Health
DAVIS, PATRICIA
DAYLEY, MEGAN
DEINES, KATHY
DEJOURNETT, KIT
DELEON,ANALISA
Denise Flowers
DESANTI, RACHELLE
DEVRIES, CHRISTAL
Devry Taylor
Diana Stephens
DINKELMAN, ROBIN
DISHMAN, JUDY
DIVERSIFIED SERVICES INC.
DOLL, EULENNA
Doty, Ashley
DRINKWALTER, DONNA
DUNN, TRAVIS
DURHAM, MARIA
DVORAK, NORENE
DYER, NANCY
E.W. INC.
EAGLE RIDGE REHABILITATION SERVICES
EASTER SEALS WYOMING
ECHO DAY SERVICES
EDWARDS, FESTI
Eileen Merritt
Elaina Oliver
Elder, Nicole
Elexis Forgey-Enis
ELITE MEDICAL SUPPLIES
ELITE THERAPY
Ellen Brown, LLC
ELLIOTT, NICHOLAS
ELLIOTT, SHARON
ELLSWORTH, DEBORAH
EMMETT, ELAINE
EMPOWERING CHOICES
Enlighten Case Management Services
EQUAL BEGINNINGS LLC
Erica Arnold
Evans, Donna
EVANS-SIMPSON, SALLY
EXCEL CASE MANAGEMENT, LLC
expressABLE
FALK, SHIRLEY
FERGUSON, COLEEN
FERGUSON, JOHN
FERRIS, ROBYN
FIELDS, GINGER
FIFE, SHAWNA
FISCHER, DIANE
FITZ, CLAYLENE
FITZGIBBONS, KELLIE
FIVE J SUPPORT SERVICES, LLC
FLETCHER, NICHOLAS
FOLKER, RANDY
FONSECA, ALICE
FORGET, CHERYL
FORTON, SUSAN
Forward Unity Case Management, LLC
FOWLER, AUNKIA
FRANKS, JUDITH
FREEMAN, YURI
FRONTIER ACCESS & MOBILITY SYSTEMS, INC.
FRONTIER WELLNESS, LLC
FRY, CRYSTAL
GABEL, ANDY
GALLAGHER, KAYLA
GARLAND, SARA
GARNER, NORMA
Garretson, Ashly
GARRETSON, LINDA
GASTON, BRAYDEN
Genuine Advocacy LLC
GERMANY-GREER, NENA
GILLIAM, ELIZABETH
GLEB, JANET
GOMEZ, NATALEE
GONZALES, MAXINE
GOOD, DIANE
GOODWILL INDUSTRIES OF WYOMING, INC.
GORRIE, PAMELA
Grace Kinkade
GRACE, REBECCA
GRANNY'S PUREST OF HEARTS
GRAY JEN
Gray, Haley
GREAHAM, JEFFERY K.
Great Joy LLC
GRECO, BETTY
GREEN, CARRIE
GREEN, JARRED M.
GREEN, SHEILA
GREEN-SHUMWAY, JOHN
GREENER PATHS, INC.
GRIFFEE, TRACY
GROTH, LINDA
Grundhoffer, Caleigh
GRUNDHOFFER, DALE
GUELDE, CHRISTINE
HABERKORN, CARRIE
HADERLIE-MAJOR, SHANDI
Haile Merritt
HALLCROFT, KRISTINA
HAMILTON, MARGARET D.
Hanna Schutzman
Hannah Stuart-Walker LLC
Hanson, Amanda
HARDESTY, JANE
HARDY, SHAY
HARRIS' HELPING HANDS
HASLAM, CHRISTINE M.
HASSLER, CHARLENE
HATFIELD, JEAN
Haylee Eggleston
HEART MOUNTAIN HEALTH CARE
Heather Foster
HEEMEYER, CANDICE
HEIL, REANNA
HEIL, SONYA
HEINTZ, ADDIE
HELLING, TIFFANY
HELPING HANDS
HENDERSHOT, NICOLE
HENDERSON, DELYNDA
HERMAN, MELISSA
HERNANDEZ, MARY
HIBBARD, GENEVA
HILLMAN, MARK
HILLYARD, JUANITA
HINER, SHARON
HITE, FRANCES
HODDER, KRISTY
HODGES, BARBARA
HOFF PATRICIA
Hoover's Peace, LLC
HOPE UNLIMITED, Inc.
Hughes Venture Holdings, LLC.
HULSHIZER, BONNIE
Hunter Peak DDSP
HURST, JAN
HUSSKE, ELIZABETH
HUTCHISON, PATRICIA
I-REACH 2 INC.
INDEPENDENT OPPORTUNITIES, LLC
INGRAM, MONICA
IRISH, JUSTIN
Ives, Desiree
Jack's Waiver Services, LLC.
Jacque Hunter
JAMES, SHARON K.
JAMESON, CHRISTY
JAMESON, MICHAEL JR
JENNIFER PETERSON
Jennifer Zierke
Jessica Hanson
Jessica Keller
JEWELL, JERI
JEWELL, SUZETTE
JIll Evelo
JL PERSONAL CARE LLC
JMBPLLC
JNM ALTERNATIVES
JOHNNIE REE, LLC
Johnson, Amber
JOHNSON, KELI
JOHNSON, KELLI M.
JONES, CARLENE
JONES, LINDA
JONES, TREENA
JUDY TILLMAN
K-N CMS
KARY, RAENA
Karyn Clark
Katherine Ford
kathy m smith
KETELHUT, SHARI
KIDD, CALLIE C.
KIER, EVELYN
KING, TRUDY
KING-MARCUS, CAROLYN
KINGDOM CLEANING
Kirsten Allphin-Independent
KKARE, LLC
KNELL ACCESS MANAGEMENT, LLC
KNIGHT, HEIDI
KOBIELUSZ TARA
KOLLMANN, SUSAN
KR SERVICES
Kristina's Karing Case Management
KRUCKENBERG, JACY
Krug, Ashley
Krystal Scott
L. ASHMENT RES. HAB., L.L.C.
LA SERVICES OF CHEYENNE, INC.
LACEY BETTY
Lacey Debusk
Lacey Young
LANDON, CLINTON
LANGE, PEGGY
Lantern Host Homes
Lara, Bonnie
LATOUSH, MONICA
Laura Arcuri
LEADING REINS, LLC
LEAP Services, LLC
LEE, CARRIE
LEE, KATHLEEN
Lee-Richardson, Aubree
LEHMAN, LISA
Leo Levengood
LESHER, MELISSA
LESTER, DENISE
LIFE CONNECTIONS, LLC
Life Empowerment Services
LIFE SKILLS IN WYOMING
LIFE STEPS OF WYOMING, LLC
LIFESTYLE ENRICHMENT LLC
LIGHT, HEATHER
LINCOLN SELF RELIANCE, INC. (LSR)
LINDBERG, WILLIAM "TUNA"
LITTLE, KAREN
LIV HEALTH
LIVE and LEARN CENTER, INC
Live Inspired LLC
LOCK CLARKE, DELINDA
LOCKLIN, VELVET
LOETSCHER, MOLLY
Logos Speech Therapy, Inc.
LONG, AMANDA
Lorrie L Wells
LOVELAND, SUSAN A./ NEW HORIZONS
Lucas-griffin, Sawyer
LUERAS, TERRY
LYNCH, ANGELA
MAGIC CITY ENTERPRISES, INC.
MANGUS, ADRIENNE
Mara vonHolst
Marilynn Sue Rodgers
MARNEY, NICOLE
MARTELL, KESHA
MARTENS, BONNIE
MARTIN, DIANA
MARTINEZ, TRACY
MARTINSEN, BREE
MATLOCK, DIANE
MAUREEN K. JOHNSON, INC.
MAYNARD, DONNA
MCCLAIN, BRANDY
McDowell, Mariah
MCFARLANE, JENNIFER
MCGUIRE, SUE ANN
MCSWAIN, DEBRA
MEDINA, DANELLE
MEEKS LAURIE
MEEKS, NANCY
MEK, LLC
MELVIS SERVICES
MERRITT, DEBBIE
METZGER, LADONNA
MEYER, LACOSTA
MEYERS, CALEY
MICHELI, ANTHONY
MICHELI, TAFFY L.
MICKELSON, MINDY
MIKULA, ASYA
MINGUS CASE MANAGEMENT
Misty Streeter
MJ JOHNSON, LLC
MOCKO, LAURA
MONTGOMERY, SHERI
MONTOYA, JANAE
MONTOYA, JANICE
MOORE, WENDY
MORRIS, ABIGAYLE
MORRISON, PEPPER
MOUNTAIN REGIONAL SERVICES, INC.
MOWER, HOLLY
MUELLER, HERLYNA
MURPHY, MARTI (ROSENBURG)
MURPHY, DALE
MURPHY, DENISE
MURPHY, L. TEMPE
MURPHY, MELINDA
MURRAY, REBECCA
My Brothers Keeper L.L.C.
Myers, Erin
Nathan Hunt
NELSON, CATHERINE
NELSON, HELEN
NELSON, JAN
NELSON, THEO
NEUMANN, KASSANDRA
New Beginnings
New Elevations, LLC
NEW HOPE HABILITATION SERVICES LLC
NEWMAN, LAUNI SUE
Next Generation Care
NextGen Care Services
NICHOLSON, ALEXANDRIA
Nicole C Armstrong
Nicole Le Marr
NIELSEN, BRANDY
Nissen, Bryttne
NO MATCH - DD
NOFTSKER, WANDA
North Ridge Homes
Northern DDSP, Inc
Norton Waiver Services, LLC
NOWCAP SERVICES
O'BRIEN, CRYSTAL
O'CONNOR, SHARON
OJA-JOHNSON, JILL R.
OKADA, CATHERINE
OKADA, PETER
OLIVER, BOBBI
OLSON, KARI
OLSON, STEPHANIE
OLSON-BUDIG, KELLIE
One to One Care
OPEN DOOR CASE MANAGEMENT
OPITZ, BETH
OPITZ, JOLAYNE
Opportunities Inc.
OPTIMUS SERVICES, LLC
Our Step Forward
OVERTURE
OWENS, LISA
OWL UNLIMITED, LLC
PALMER, JENNIFER
Pamela Helping Roo, LLC
PANTLE, LLC
PARSONS, ANDREA
PARSONS, TIMOTHY
PASS, INC.
PATTERSON, LUCINDA
PATTON, JULIA
Peak Behavioral Services, LLC
PEGASUS CASE MANAGEMENT
PENA, LLC
PENUEL, JAMES III
Peter M Estay
PETERS CMS, ALYCE
PHOENIX RISING SERVICES, LLC
PICKLE, DEBORAH R.
PIMENTEL, GINA
PINKERTON, SHANNON
PINKERTON, TROY
Pioneer Carpentry LLC
PORRAS RESORT, LLC
Positive Step LLC
POTZERNITZ, LISA
PREUSSE, TAYLOR
PREVETT, DONNA
PRILL, TINA
PULLEN-, KINISHA
Purposeful People INC
QRC, LLC
QUALITY CARE, LLC.
QUALITY CASE MANAGEMENT
QUALITY HOME HEALTH CARE
QUINLAN-WILLARD, JILL
R ESCORT SERVICE
RAINBOW PHYSICAL THERAPY SERVICES
RANEY, SABRINA
RAVER, MARY
RAVER, RANDY
RCR INSPIRATIONS LLC.
READY, NANCY LYNNE
Rebekah Vondenkamp
REDDING, COLLEEN
REDDING, KATHLEEN
RENEW
RENEWED HOPE FOUNDATION, INC.
RESOURCES
Revolution
REX, MICHELLE S
RICHMOND, DEBBIE J.
Rikki Vondenkamp
RILEY, SANDRA
ROBERTS, MO (Maureen)
ROCCARO, ALICIA
Rochelle Denevan
ROCKWOOD, CAROLYN
ROCKY MOUNTAIN THERAPY
RODRIGUEZ TINA
ROHRICH, LISA
Roko Ranch LLC
ROSIER, TAMMIE
ROSIER, TAMMY
ROWLAND SARAH
Samantha Christensen
Samantha Rubin
SAND, MARK
SANDERS, LORI
SANTEE, BILLIE JO
SANTISTEVAN JENNIFER
Sarah Blake
Schmidt, Christine
SCHRAM, LORI
SCHULTZ, SHELLY
SCHULZ, LINDA
SCHWARTZ, SHARON
SCOTT'S HOME IMPROVEMENT
Shaffer, Jamie
Sharon's Home Health Care
Shawn Schreiner
Shawna Jones
Shaylee McMullen
Sheena M Lambert
Shelby Elliott
Sherry Merritt
Shirley K Cassell
SILENT STEPS, LLC
SILVER LINING HEALTH SERVICES, LLC
Simon and Simon LLC
SIMPLY SUPPORTS
SINKS CANYON THERAPY
SKINNER, MAUREEN
SL SERVICES, LLC
SLANE ALMA
SMALL, RHONDA
SMITH, MAUREEN
SNYDER, ANDREA
SOL DOMUS, INC.
SOLID GROUND, INC
SOSA, ANA
Southeast Wyoming Life Enrichment Program LLC
SPARKS, ELISABETH
SPECIALTY EQUIPMENT, LLC
ST.GILES LLC
STAINBROOK HARMONY HOUSE-HS
STAINBROOK HARMONY HOUSE-JS
STANDARDS HABILITATION SERVICES LLC
STAR SHINE INC.
Star Valley Special Care Services
STEED, NANCY
STEPHANIE SUMNER LLC
STEPHENS, GINA ANN
STEPHENSON, CINDY
Stewart Care LLC
STEWART, DANIEL
STEWART, KAREN
STICKS, LLC
STIRRETT, CINDY
STIRRETT, TIMOTHY
STOCKS, TANYA D
Stone Waiver Services LLC
STOWE LLC
STROSNIDER, PEGGY
Susan Davis
SYVERTSON, RALPH
SYVERTSON, SANDRA
Tabitha Sockey
Tamara Greenlee
Tammy Fausett
Tanya Hanson
TAPONI ANIMAL THERAPY, LLC
Taylor, Margaret
Teneil Sullivan
Terri Johnson
THEUNISSEN, TINA
THEUNISSEN, TOM
THOMAS DEBRA
THOMAS, HEATHER
THOMPSON, RUTH
THORNOCK, SHAROL
Tiana M. Preator
TIFFANY'S LOVING CARE, LLC
TILLARD, ASHLEE
TOBII DYNAVOX, LLC
Tracy Deschampe Sage
TREASURE ABILITIES CASE MANAGEMENT SERVICES
Tree of Life LLC
TREESE, LINDA
Twomey, Gloria
UNDERWOOD, CRYSTAL
URRUTY, JANE
Valorie Hofmeister
VASCO, LILLIE
Versatile Services (RTEG)
Victor Orr
Vik's Little Giggles LLC.
VOIGT, HEATHER
VOLTMER, FRED
VOLTMER, JAN
VON KROSIGK, CASSANDRA
WAGNER, TARA COLLEEN
WALKER, KATHRYN
WATSON, CHARLES SCOTT
WATSON, DECILLA
WEBB PAMELA
WEICKUM, DEB
WEINERT, ANDREA
WELCH, CRYSTAL
WELCH, LEE
Wendy Carver
WENGER, CHARLENE
WETTERLUND, JANET
WHITE, CINDY R.
WHITELEY AMY
Wilde, Katie
WILLIAMS, GEORGIA MARIE
WILLIAMS, SHARLEEN
WILLIS, DENISE
WILLIS, KATHERINE
WILMES II, FLOYD D
WINDS OF CHANGE, LLC.
WINFREY, MALLORY
Winter, Carolyn
WOODS DUNEMAN, JENNIFER
WOODS INTERIORS
WORLEY, LOREECE
YOUR LIFE YOUR RIGHTS YOUR CHOICE!
Yvonne Arellano Martinez
ZAK-ARMISTEAD, MELISSA
Zenith Business Services
ZICKEFOOSE, DENISE
ZIMMERMAN, SHANNEN
ZYLBERBERG, DEBRA
If other, please specify:
Provider/ Staff Name
Provider/ Staff Phone
Did this incident occur while participating in remote support service?
Yes
No
Duty to Report:
Adult Protection Services Act
Child Protection Services Act
Incident Description
Click for Definition
Incident Type
DFS Notification
Select
Suspected Abuse
Required
Suspected Self Abuse
Required
Suspected Neglect
Required
Suspected Self Neglect
Required
Suspected Exploitation
Required
Suspected Abandonment
Required
Death
Required
Intimidation
Required
Sexual Abuse
Required
Police Involvement
N/A
Crime Committed By Participant
N/A
Injuries Caused By Restraints
N/A
Serious Injury
N/A
Elopement
N/A
Medication Error
N/A
Use of Restraint
N/A
Medical/Behavioral Admission
N/A
Other Injury
N/A
Preceding Events
Description of Incident
Actions Taken
Get DFS Contact Info
DFS Contact Information
Select Location:
AFTON
BUFFALO
CASPER
CHEYENNE
CODY
DOUGLAS
EVANSTON
GILLETTE
GLENROCK
GREYBULL
JACKSON
KEMMERER
LANDER
LARAMIE
LUSK
LYMAN
NEWCASTLE
PINEDALE
POWELL
RAWLINS
RIVERTON
ROCK SPRINGS
SHERIDAN
SUNDANCE
THERMOPOLIS
TORRINGTON
WHEATLAND
WORLAND
Address:
ZIP Code:
Phone:
Hours:
Notifications
Contact
Contact Name
Date Contacted
How Contacted
Department of Family Services
Phone
Fax
Internet/Email
InPerson
Protection and Advocacy
Phone
Fax
Internet/Email
InPerson
Division
Phone
Fax
Internet/Email
InPerson
Case Manager
Phone
Fax
Internet/Email
InPerson
Guardian (if applicable)
Phone
Fax
Internet/Email
InPerson
Law Enforcement Agency (if applicable)
Phone
Fax
Internet/Email
InPerson
* Note: After you select "Submit" you will go to a Confirmation page where you will be able to Print the Incident Report.
Herschler Building, 122 W. 25th Street, 4 West, Cheyenne, WY 82002 E-Mail: ddmail@health.wyo.gov • WEB site: https://health.wyo.gov/healthcarefin/dd/ Phone (307) 777-7115 • Toll Free (1-800) 510-0280 • Fax (307) 777-6047 • TTY (307) 777-5578