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Anytime an unusual incident (UI) or major unusual incident (MUI) occurs, Providers must document the occurrence on an Unusual Incident Report (UIR) form. It is the Provider’s responsibility to complete and submit the UIR in compliance with the requirements of Rule.

Providers must maintain copies of all UIRs completed, as well as their monthly UI Log and complete the Annual MUI Analysis.

Monthly UI Log Form

Annual MUI Analysis Form

  • This form is sent out via email at the end of each year. If you provide services in Lake County and have not received the form by the end of the calendar year, please reach out to

For more information about Reporting MUIs and/or to report an MUI, visit our MUI webpage or call (440) 350-5253 (LAKE).

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