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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

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Suicide Reporting Form

The Suicide Reporting Form (SRF) [PDF - 401 KB] is a data collection tool designed by Indian Health Service/Tribal/Urban (I/T/U) subject matter experts (including psychiatrists, psychologists, social workers, and alcohol and substance abuse providers), and is used to document suicide-related events in the patient’s medical record. Training is available as is the presentation, "How to Use the Suicide Reporting Form."

NOTE: This form is intended as a data collection tool only. It does not replace documentation of clinical care in the medical record, and it is not a referral form.

Why is Using the Suicide Reporting Form Important?

Completed Suicide Reporting Forms in the patient’s medical record are important because they:

  • Provide health care professional and treatment team information related to past history and risk factors.
  • Support and ensure continuity of care and services.
  • Provide health care professionals with information for a better understanding and ability to prevent suicide.
  • Provide needed information on suicide-related crisis.
  • Ensure cross communication between providers and services for suicide-related events.

Why is Data important?

Data helps to identify opportunities to tailor interventions in medical, behavioral health, and community settings to save lives. Data provides information to clinical staff to better meet patient needs and to provide appropriate services at all levels of care.