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Restraint and Seclusion Monitoring

QI-CIR-003 Restraint and Seclusion Monitoring outlines the process of submitting the Report of Restraint or Seclusion form (PDF).

A Report of Restraint or Seclusion form (PDF) must be completed for all restraints or seclusions that do not result in Member injury requiring treatment greater than first aid for any services that are funded by PerformCare.

A Critical Incident Report form (PDF) must be completed instead of the Report of Restraint and Seclusion Form for the following:

  • If a prone restraint occurs.
  • If an injury occurred during a restraint or seclusion.
  • Improper use of restraint or seclusion.

Providers must follow all internal policies and procedures, all PerformCare policies, and all applicable regulations related to the use of seclusion and restraint.