MedicaidAdministrativeLow impact
Supportive Living Facility Provider Handbook Update - Form HFS 3869, Medication Error Report
Illinois Medicaid - HFS·IL · Pharmacy, Geriatrics·Provider Notice
Effective date
Aug 13, 2007
We identified it
Jun 21, 2026
Summary
Illinois Department of Healthcare and Family Services now requires supportive living facilities to use a new standardized Form HFS 3869 for reporting medication errors. The form must be completed for all medication errors and kept in resident files, with serious errors resulting in hospitalization reported to regional supervisors within 24 hours.
Action Required
Effective August 13, 2007: Supportive living facility staff must use new Form HFS 3869 to report all medication errors and include completed forms in resident files. For medication errors causing hospitalization due to adverse reactions, facilities must report to HFS Regional Supervisor within 24 hours of discovery. Update facility handbook by removing pages 23 and Appendix C Index and placing new Appendix C-20 between C-19 and C-21.