000 DHHS test pageResourcesFor you, CQI staff! Just a page to test some things Fatality reporting form Your name Your email Your phone number Case number (optional) Client name DHHS agency you are referring to —Please choose an option—Adult Protective Services (APS)Division of Child and Family Services (DCFS)Division of Juvenile Justice and Youth Services (JJYS)Division of Services for People with Disabilities (DSPD)Office of the Public Guardian (OPG)Utah State Developmental Center (USDC)Utah State Hospital (USH) Client age Client gender —Please choose an option—MaleFemalePrefer not to answer Client race —Please choose an option—American Indian/Alaska NativeAsianBlackNative Hawaiian/Pacific IslanderWhiteUnknownOther Client ethnicity —Please choose an option—HispanicNot Hispanic Client date of birth Type of incident —Please choose an option—FatalityNear fatality Date of incident Type of services open at time of incident Circumstances surrounding the fatality/near fatality File upload, 12 MB limit (Only .pdf, .doc, .docx, .jpg, .jpeg, .png permitted) Second file if needed, 12 MB limit (Only .pdf, .doc, .docx, .jpg, .jpeg, .png permitted) If you need to submit an additional file type or a larger file, please send it to [email protected] with your name and contact information About Us What We Do What We Can't DoContact Us Your location Search radius 10 mi25 mi50 mi100 mi200 mi500 mi Results 255075100