| Adolescent Suicide Attempt Data System |
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| Purpose |
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Oregon hospitals are required by law to report adolescent suicide attempts to the Oregon Public Health Division. These reports are used to:
- Estimate the magnitude of suicide attempts among Oregon adolescents and monitor possible increases, decreases and trends.
- Understand factors associated with suicide and suicide attempts among adolescents.
- Increase public awareness and develop programs that support suicide prevention.
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| Reporting Protocol |
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Reporting Protocol (PDF)
Additional instructions for reporting are located on page two of the reporting form.
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| Forms |
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For each attempt, a reporting facility must submit the following form to the Injury Prevention Program: Adolescent Suicide Attempt Report Form (PDF).
For facilities where no attempts have occurred within a reporting period (month), the following form must be submitted to the Injury Prevention Program: ASADS Zero Attempts Form (PDF).
Forms should be submitted by the 15th day of each month, for events that occurred in the previous month (for no attempts, submit zero attempts form).
Please fax forms to (971) 673-0990. Fax is confidential and secure.
Although fax forms are preferred, forms can be mailed to:
Adolescent Suicide Attempt Data System
Injury and Violence Prevention Program
800 NE Oregon Street, Suite 772
Portland, OR 97232
The Injury and Violence Prevention Program does not provide postage-paid return envelopes.
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