Request Call Back to Report

Immediately upon the occurrence of a potentially reportable event (as soon as the patient’s needs are addressed), notify your Self-Insurance Program by calling:

For staff/faculty use only, if you are unable to call at this time, please complete and submit the below. We will do our best to call you during your requested time.

Which program are you with? *
Your Name *
First
Last
Title or Profession (e.g., Department Chair, MD Faculty, MD Resident, APRN) *
Your Phone Number *
Best Time To Contact (between 8AM and 5PM)
Name

This webpage, Report Now, is managed by Arlene Smillov, BSN, MBA, Claims Officer.

Please feel free to contact her for any questions or recommendations regarding page content.