Revised OBS Adverse Event Reporting Form

Below is a copy of the revised OBS Adverse Event Reporting Form. The form has been distributed to all accredited OBS practices throughout the state and posted to the Department's OBS webpage. Changes to the form were made to improve standardization of information reported and reduce the need for offices to provide the Department with medical records. The form can be filled out on the computer but at this time still needs to be copied, signed and sent to the Department via certified mail. The old version of the form will be accepted through the end of June but outdated versions of the form received after that will need to be re-submitted.

If you have any questions, feel free to contact the OBS mailbox at: obs@health.state.ny.us.  

Guidance for Reporting an OBS Adverse Event 

Office-Based Surgery - Adverse Event Report Form