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
Fontanelle
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-Adult Day Services (Basic)
S5108-ADS HGH
S5100UA-Adult Day Services (Intermediate)
97152-Behavioral Support Services (BCABA Level)
97151-Behavioral Support Services (BCBA Level)
97153-Behavioral Support Services (RBT Level)
T1016 UB - CM Certificate Tier - 15 Min
T2022 UB - CM Certificate Tier- Monthly
T1016 - Case Management 15 min
T2022-Case Management
T2027HA-Child Habilitation Services (0-12)
T2027-Child Habilitation Services (13-18)
H2014-Cognitive Retraining
T2017 - Community Living Services Basic
T2031-Community Living Services Basic Daily
T2017UN - Community Living Ser
T2017UP - Community Living Services
T2016UD - Community Living Ser
T2016 - Community Living Services Level 3 Daily
T2016U7 - Community Living Serviced (Level 4 Daily)
T2016U6 - Community Living Services (Level 5)
T2016U5 - Community Living Services (Level 6)
T2021 - Community Support Services
T2021HB - Community Support Services High
T2021U1 - Community Support Services Intermediate
S5135TT CG3
S5135-Companion Services
H2011-Crisis Intervention
S9470-Dietician
S5165-Environmental Modification
T2029NU-Specialized Equipment
T2029-Specialized Equipment Repair
S5130-Homemaker
S5165NU-EnviroModifications
T2038 - Individual Habilitation Training
97139-OT
97532-Occupational Therapy Session
T1019-Personal Care
97110-Physical Therapy
T2015TF-Prevoc Inermdt LOC
T2015HJ-Prevocational High
T2015TG-Prevocational High
T2015U2-Prevocational Intermediate
97150-PT/OT GROUP
T1005-Respite Care
T1005HQ Respite Group 15 minut
S5151 Respite Individual/Daily
S5151U8 Respite Group/Daily Unit
T1002-Skilled Nursing
T1001 - Skilled Nursing Assess
T2033-Special Family Habilitation
92507-Speech Therapy Individual Session
92508-Speech Therap. GRP Session
T2019U8-Supported Employment (Individual)
T2019TS-Supported Employment (Follow Along)
T2019UQ-Supported Employment Group
T2019-Supported Employ Individual
T2023-Targeted Case Management
T2003-Transportation
T2001 - Transportation - per
A0090 - Transportation - per
If other, please specify:
Organization
4 V, LLC
5150 Case Management
A Better Life, Inc.
A+ COMMUNITY SERVICES
AAA Angela Thomas
AAI SERVICES
Abilities and Beyond
ABILITIES AND BEYOND (old)
ABILITIES PLUS
Able Hands
Accomplishing More Together
ACES$
ACHIEVING GREATNESS LLC
ADVANCING ABILITIES
Affinity Services
AFII LLC
Albert Dennis
ALIGN SERVICES LLC
All Abilities Reached
ALL ABOUT FAMILY
All Children Matter LLC
ALL FOR YOU LLC
All in Andilyn Time, LLC
ALLIANCE FOR SELF DETERMINATION, INC
ALLIES IN ADVOCACY
Alma Law
Aloha Caring Hands of Wyoming
Alpine Case Management
AltaMeta Enterprises
ALTERNATE PATHWAY
Always at Home LLC
Alyce Peters
Alysha Rewerts
Amanda Baldes
Amanda Jones
Ambrit Care LLC
Anchored in Hope
Another Path Forward
April Constantine
ARCHER, CHERYL
Arcuri Disability Services, LLC.
ARK REGIONAL SERVICES
ASAY, JAMIE
Ashley Singleton
Aspire Nursing
Aspiring Advocates of Wyoming LLC
Audra Mullins
Aunkia Fowler and Associates
B.A.C.A. Case Management LLC
Bailee McFarlane
BANGS, DANIELLE
BARRETT, JANET
Be the Change, LLC
Be You, LLC
Beacon Independency Center
BELIEVE, LLC
Bennett Case Management, LLC
BENNETT, KRISTIE
Berg, Stefanie
Bertha Lee Allen
BEST HOME HEALTH
BEST, EMMA
BIG HORN ENTERPRISES, INC.
Blanca Iris Sanchez-Rosas
BLESI (PEPPLE), DENISE
BLESI, TAMARA
BLUEMEL, CHARLYN R.
Bobbie Finn
BOHN, LINDA
Borcher, Jessi
BOUCHARD, JULIE
BOWEN, TERESA
Bower, Jessie Lynn
BOWER, PAM
BOYER, AMY
BOYLES, PENNY
BRAIN INJURY ALLIANCE OF WYOMING
Breanna Holdsworth
BREAZEALE, JANET
Brenda Pina Hemeyer
Brenda S Armstrong
BRIDGES OF WYOMING
BRITT, DELAINE
BRITTAIN, JUDY
Brooke Elardi
Brooke Lehto
BRUSKI, KAM
Bryanna Williams
BUDIG, PATRICIA
BUECHLER, CHRISTIAN
BUI, LISHA
BURDEN, TONISHA
Busy Bees Homecare
BYBEE ENTERPRISES, LLC
CABANAG, COURTNEY
CAIN, CHARLENE
CALDWELL, ASHLEY
CAMPBELL MELISSA JO
CAMPBELL, JESSICA
Candyce Peters
CANNON, SANDRA
CARE WY LLC
Caregivers of Wyoming, LC
Caring Case Management
Caring Connections, LLC
CARING HEARTS CASE MANAGEMENT
Caring Tender Hearts
Cascabel Investments
Case Management & Advocacy LLC
CASE MANAGEMENT FOR POSITIVE SOLUTIONS
CASE MANAGEMENT SERVICES OF WYOMING
Cassidy Krueger
CASTRO, JOE
CB CASE MANAGEMENT, LLC
Chantall Cherry
Charla Ricciardi
CHARLES, ELLIS TIMOTHY
CHAVEZ, BERTHA
CHEATHAM, PEGGY R.
Chelsea Davis
Cheyenne Hab & Therapeutic Center
CHICO, JESSICA
ChitChat, LLC
CHOICES AND CHANGES LLC
Christine Beckett
CJ & Friends
CMS, INC.
COLE, PAULA
COMMUNITY ENTRY SERVICES
CONNECTIONS OF THE HEART LLC
Connie Silvan
CONRAD, LORIE
Conscious Care
Constant Companion LLC
COOK, KANDI
COONIS, JAMES
COOPER, NICOLE
COOPER, SHAWNDRA
CORBIN, KIMBERLY
CORNEJO, DESIRAE
Cottonwood Homes, LLC
Count Abilities Case Management
Courtney Page
COURTNEY, MARK
COWBOY CARES, INC
CRECELIUS, SANDRA
Cricket Home Health, LLC
CROFT ESTAY, CAROLINE
CROSBY, SYLVIA
Cura's GATE, LLC
Currah, Arian
Cynthia J.Weed
DALLMAN, CAILYN
Danelle Tong
Danielle Olsen
Darbi Hamsher
Dawn Haberman
DAYLEY, MEGAN
Debra Stone
DEJOURNETT, KIT
DESANTI, RACHELLE
Desired Dignities LLC
DEVRIES, CHRISTAL
Devry Taylor
Diana Lee Martin
Diana Stephens
Dina Whitted
DINKELMAN, ROBIN
DISHMAN, JUDY
DIVERSIFIED SERVICES INC.
Doty, Ashley
DUNN, TRAVIS
DYER, NANCY
Dynamic Support LLC /Tiffany Rein
EAGLE RIDGE REHABILITATION SERVICES
EASTER SEALS WYOMING
ECHO SERVICES, LLC
Eileen Merritt
Elaina Oliver
Elder, Nicole
Elevate Case Management
Elevated Empowerment
Elisha Reno
ELITE THERAPY SERVICES LLC
Ellen Brown, LLC
ELLSWORTH, DEBORAH
Emanate Abilities LLC
EMPOWERING CHOICES
Enchanting Dreams 4 You LLC
Endeavoring Abilities, LLC.
Enlighten Case Management Services
Envision Empowerment LLC
EQUAL BEGINNINGS LLC
ET Community Services
Evans, Donna
Evenstar Case Management LLC
EverGreen Case Management
FERGUSON, COLEEN
FERRIS, ROBYN
Fiorella Parraga
FIVE J SUPPORT SERVICES, LLC
FLETCHER, NICHOLAS
For Zayden, LLC
Forward Unity Case Management, LLC
FOWLER, AUNKIA
FRONTIER ACCESS & MOBILITY SYSTEMS, INC.
GALLAGHER, KAYLA
Gano LLC
GARLAND, SARA
GARNER, NORMA
Garretson, Ashly
GARRETSON, LINDA
Genuine Advocacy LLC
Glen Garcia
Gloria Molt
GOODWILL INDUSTRIES OF WYOMING, INC.
GORRIE, PAMELA
Grace Kinkade
GRACE, REBECCA
GRAY JEN
Great Joy LLC
GREEN, CARRIE
GREEN, JARRED M.
GREENER PATHS, INC.
GRIFFEE, TRACY
Griselda M. Brower
GROTH, LINDA
Grundhoffer, Caleigh
GUELDE, CHRISTINE
Haile Merritt
HAMILTON, MARGARET D.
Hanna Brandt
Hannah Stuart-Walker LLC
HARDESTY, JANE
HARDY, SHAY
HARRIS' HELPING HANDS
HASLAM, CHRISTINE M.
HATFIELD, JEAN
Haylee Eggleston
Heart Mountain Healthcare LLC
Heart to Heart Case Management Services of Wyoming, LLC
Heather Foster
Heather Thomas
HEEMEYER, CANDICE
HEIL, SONYA
HEINTZ, ADDIE
Helen Jenkins
HELLING, TIFFANY
HelpIan, LLC
Helping Hearts Connect, LLC
Helping Others LLC
HENDERSHOT, NICOLE
HENDERSON, DELYNDA
HERMAN, MELISSA
HIBBARD, GENEVA
HILLMAN, MARK
HILLYARD, JUANITA
HINER, SHARON
HITE, FRANCES
Holland Gaston
HOLLINGSWORTH, KELLIE
Home Life Care, LLC
Home Life Care, LLC (Old)
Hoover's Peace, LLC
Hope Eye
HumanKind LLC
Hyland Nursing Services, LCC
I-REACH 2 INC.
INDEPENDENT OPPORTUNITIES, LLC
Individualized Case Management LLC
Inka Care LLC
InspireCare, LLC
IRISH, JUSTIN
Ives, Desiree
Jacque Hunter
Jacquie West
JAMESON, CHRISTY
Jay Blakemore
JEANRAPHAEL DE RAOULX
JEFFERS, TIERNEY
Jenna Evans Gentle Care L.L.C.
Jennifer Clark
JENNIFER PETERSON
Jennifer Thompson
Jennifer Zmiewski
Jenny McKinney
Jessica Hanson
Jessica Holder
JEWELL, JERI
Jiselle McKee
JL PERSONAL CARE LLC
JMBPLLC
JNM ALTERNATIVES
Jodi Thornhill/ANB Care Services
John Pintello
JOHNSON, KELI
JOHNSON, KELLI M.
JONES, CARLENE
JONES, LINDA
Jordan Glause
Journies
JUDY TILLMAN
K-N CMS
KARY, RAENA
Kassandra Neumann
Katherine Ford
Kathryn Osborne
kathy m smith
Kelsie Tarver
Kendall Smithmen
KETELHUT, SHARI
KIDD, CALLIE C.
KIER, EVELYN
Kim Hofer
Kimberly Eubank
Kindred Souls of Wyoming LLC
KING, TRUDY
KINGDOM CLEANING
Kirsten Allphin-Independent
KKARE, LLC
KNELL ACCESS MANAGEMENT, LLC
KOBIELUSZ TARA
KOLLMANN, SUSAN
KR SERVICES
Kristen Winters
Kristin Taylor/Taylor'd Case Management Services
Kristina's Karing Case Management
KRUCKENBERG, JACY
Krystal Scott
L. ASHMENT RES. HAB., L.L.C.
LACEY BETTY
Lacey Young
LANGE, PEGGY
LATOUSH, MONICA
Laurie Lyon
LEADING REINS, LLC
Leanne Silva
LEAP Services, LLC
LEE, CARRIE
LEE, KATHLEEN
Lee-Richardson, Aubree
LEHMAN, LISA
Leo Levengood
LESHER, MELISSA
Leslie Goeppinger
LESTER, DENISE
Lidia Cervantes
LIFE CONNECTIONS, LLC
LIFE SKILLS IN WYOMING
LIFE STEPS OF WYOMING, LLC
LIGHT, HEATHER
LINCOLN SELF RELIANCE, INC. (LSR)
LINDBERG, WILLIAM "TUNA"
Lion's Disability Transport Service
LIV HEALTH
LIVE and LEARN CENTER, INC
Live Inspired LLC
LOCKLIN, VELVET
Logos Speech Therapy, Inc.
LONG, AMANDA
Lorrie L Wells
Love And Embrace Differences LLC
Lucas-Griffin, Sawyer
LUERAS, TERRY
LYNCH, ANGELA
MAGIC CITY ENTERPRISES, INC.
MaiKou Thao
MANGUS, ADRIENNE
MARNEY, NICOLE
MARTELL, KESHA
MAUREEN K. JOHNSON, INC.
MCFARLANE, JENNIFER
Meadowlark Case Management, LLC
MEDINA, DANELLE
MEEKS LAURIE
MEK, LLC
Mellissa Olson
MERRITT, DEBBIE
METZGER, LADONNA
MEYERS, CALEY
MICHELI, TAFFY L.
MICKELSON, MINDY
MIKULA, ASYA
MINGUS CASE MANAGEMENT
Misty Cardera
Misty Mejia
Misty Streeter
MORRISON, PEPPER
Motivating Change Case Management
MOUNTAIN REGIONAL SERVICES, INC.
MOWER, HOLLY
MUELLER, HERLYNA
MURPHY, DALE
MURPHY, DENISE
MURPHY, MELINDA
MURRAY, REBECCA
My Brothers Keeper L.L.C.
NELSON, HELEN
Nevada Thompson
New Beginnings
New Elevations, LLC
NEW HOPE HABILITATION SERVICES LLC
NEWMAN, LAUNI SUE
Next Generation Care
Nicole C Armstrong
NIELSEN, BRANDY
Nikki Green Advocacy & Consulting
Nissen, Bryttne
Noamie Niemitalo
Noble Adult & Youth Services
Noemi Hernandez
Northern DDSP, Inc
NOWCAP SERVICES
OJA-JOHNSON, JILL R.
OLIVER, BOBBI
OLSON, KARI
OLSON-BUDIG, KELLIE
One to One Care
OPEN DOOR CASE MANAGEMENT
Opportunities Inc.
OPTIMUS SERVICES, LLC
Our Step Forward
OVERTURE
OWENS, LISA
OWL UNLIMITED, LLC
PARSONS, TIMOTHY
PASS, INC.
PATTERSON, LUCINDA
Peace of Mind: Your Journey, Your Way
PENA, LLC
Penny Jo Parnell
Personalized Support Services
Peter M Estay
PHOENIX RISING SERVICES, LLC
PICKLE, DEBORAH R.
PIMENTEL, GINA
PINKERTON, SHANNON
Plouffe, Shawna
polly griffith
PORRAS RESORT, LLC
Positive Step LLC
POTZERNITZ, LISA
PREVETT, DONNA
PRILL, TINA
PULLEN, KINISHA
QRC, LLC
QUALITY CARE, LLC.
QUALITY CASE MANAGEMENT
QUALITY HOME HEALTH CARE
RAINBOW PHYSICAL THERAPY SERVICES
RANEY, SABRINA
RAVER, MARY
RCR INSPIRATIONS LLC.
Rebekah Vondenkamp
REDDING, COLLEEN
Renee Padilla
RENEWED HOPE FOUNDATION, INC.
RESOURCES
Riley Fisk
RISE Services, Inc.
ROBERTS, MO (Maureen)
Robin Bennett
Rochelle Denevan
ROCKY MOUNTAIN THERAPY
RODRIGUEZ TINA
ROHRICH, LISA
Roko Ranch LLC
ROSIER, TAMMY
ROWLAND SARAH
Roxanne DeClue
SAND, MARK
SANDERS, LORI
Sandra Leonard
SANTISTEVAN JENNIFER
Sarah Kludy
Sarah Lowe
Sarah Scharosch
Schmidt, Christine
SCHULTZ, SHELLY
SCHULZ, LINDA
SCHWARTZ, SHARON
Shanna Pearce
Shawn Schreiner
Shawna Jones
Shearin Case Management LLC
Sherry Merritt
ShineNLife
Shoreline Provider Services, LLC
Shumway Provisions of Wyoming, LLC
SILENT STEPS, LLC
Simon and Simon LLC
Simpl Care Services, LLC
Simply Noble LLC
Simply Supports, LLC
SINKS CANYON THERAPY
SL SERVICES, LLC
SNYDER, ANDREA
Sol Domus Group, LLC
SOL DOMUS, INC.
Sole Connections Case Management
SOLID GROUND, INC
SOSA, ANA
SPARKS, ELISABETH
SPECIALTY EQUIPMENT, LLC
ST.GILES LLC
STAINBROOK HARMONY HOUSE-HS
STANDARDS HABILITATION SERVICES LLC
STAR SHINE INC.
Star Valley Special Care Services
STEPHANIE SUMNER LLC
Stephanie Williams
STEPHENS, GINA ANN
STEPHENSON, CINDY
Steve Nelson
Stewart Care LLC
STICKS, LLC
STIRRETT, TIMOTHY
Stone Waiver Services LLC
Sunny Whitesides Greenwell
Sunshine Care Company
Tabitha Sockey
Tamara Greenlee
Tammy Wardlow
Tanya Hanson
TAPONI ANIMAL THERAPY, LLC
Tasia Juoni
Taylor, Margaret
Temple Neurodevelopmental LLC
Teneil Sullivan
Terrie Jasso
The Arc of Natrona County
THEUNISSEN, TINA
THOMAS DEBRA
THOMPSON, RUTH
Tiana M. Preator
TIFFANY'S LOVING CARE, LLC
TOBII DYNAVOX, LLC
Together Forward LLC
Tracy Deschampe Sage
TraSea Cares Respite Services
TREASURE ABILITIES CASE MANAGEMENT SERVICES
Treasure Chest LLC
Tree of Life LLC
TREESE, LINDA
Triple C
Triple Cross Caretakers
Troy Pinkerton
TruHart, LLC
Twomey, Gloria
Tyler Sand
UNDERWOOD, CRYSTAL
Up, Up and Away LLC
Vallory Dodson
Valorie Hofmeister
Valued Abilities
VASCO, LILLIE
Vicky Snider
Victor Orr
Vik's Little Giggles LLC.
VOIGT, HEATHER
VOLTMER, FRED
VOLTMER, JAN
VON KROSIGK, CASSANDRA
WALKER, KATHRYN
WATSON, DECILLA
WEICKUM, DEB
WELCH, CRYSTAL
Wendy Bowman
Wendy Carver
Wendy Lester
WENGER, CHARLENE
WHITE, CINDY R.
Whole Case Management
Wildflower Case Management, LLC
WILLIAMS, SHARLEEN
WILLIS, DENISE
WILLIS, KATHERINE
WILMES II, FLOYD D
Wind River Auto LLC
Winter, Carolyn
WOODS DUNEMAN, JENNIFER
Yvonne Arellano Martinez
ZAK-ARMISTEAD, MELISSA
If other, please specify:
Provider/ Staff Name
Provider/ Staff Phone
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Duty to Report
Adult Protection Services Act
Child Protection Services Act
Incident Description
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Incident Type
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Suspected Abuse
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Suspected Self Neglect
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Suspected Exploitation
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Suspected Abandonment
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Death
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Intimidation
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Sexual Abuse
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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
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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
Contact
Contact Name
Date Contacted
Contact Method
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