To New York State Office-Based Surgery Organizations Accredited by AAAHC

According to the New York State Department of Health, each designated accrediting agency is required to collect adverse event data from office-based surgery practices it accredits. If your organization is accredited by AAAHC, the following procedure applies to you.

At the time a reportable adverse event, as defined by New York State Public Health Law, is reported to the New York State Department of Health, you must also report certain information to AAAHC. Do not submit to AAAHC a duplicate copy of completed form NY DOH-4431. Please complete the attached form and return to AAAHC.

Please click here to download the form.

How to submit this form:

• To submit your completed form electronically, send it as an email attachment to NewYorkReporting@aaahc.org, OR

• Mail the completed paper copy of the form to the AAAHC, Attention New York Reporting, 5250 Old Orchard Road, Suite 200, Skokie, IL 60077. We strongly recommend using a trackable shipping method, OR

• Fax a copy of your form to the AAAHC at 847-853-9028. We strongly recommend using a trackable document receipt.

If you have questions about the New York Adverse Event Reporting, please contact the New York Department of Health or review the Office-Based Surgery Frequently Asked Questions http://www.health.state.ny.us/professionals/office-based_surgery/obs_faq.htm.
The following link is to the New York Guidelines for Reporting Adverse Event http://www.nyhealth.gov/forms/instructions/doh-4431_instrucions.pdf.