CMS Moves Restraint and Seclusion Death Reporting Form to New Digital Platform
(Oct. 2, 2026) – The Centers for Medicare & Medicaid Services transitioned Form CMS-10455 — Report of a Hospital Death Associated With the Use of Restraint or Seclusion — from the Qualtrics platform to the iQIES platform, effective Sept. 21.
Hospitals and critical access hospital distinct part units are required to submit the form, which now is accessible directly through iQIES.
To help facilities adjust to the new platform, CMS shared a brief instructional video on how to complete and submit the electronic form.
Additional information about this change can be found in this CMS memo.
--Larry Van Der Wege