Behavioral Health Incident Report

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I. Incident Details

• Date: May 20, 2050

• Time: 2:00 PM - 2:45 PM

• Location: [Your Company Address], Room 203

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II. Individuals Involved

• Mr. John Doe (Patient ID: 12345)

• Nurse Sarah Johnson (Staff ID: 6789)

• Therapist Michael Smith (Staff ID: 4567)

• Therapist Assistant Emily Brown (Staff ID: 7890)

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III. Description of Behavior

On May 20, 2024, at approximately 10:30 AM, an incident of aggression occurred in Room 203 of the [Your Company Name]. The incident involved a patient, Mr. John Doe (Patient ID: 12345), who displayed aggressive behavior towards clinic staff during a group therapy session.

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IV. Interventions

• Nurse Sarah Johnson immediately alerted clinic security and requested assistance.

• Therapist Michael Smith attempted to verbally de-escalate the situation while Therapist Assistant Emily Brown escorted other patients out of the room for their safety.

• Upon the arrival of security personnel, Mr. John Doe was safely restrained and removed from the therapy room.

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V. Follow-up Actions

• Mr. John Doe was escorted to a designated quiet room for further assessment and monitoring by nursing staff.

• Therapist Michael Smith and Therapist Assistant Emily Brown provided debriefing sessions for other patients affected by the incident.

• The nursing staff conducted a thorough assessment of Mr. John Doe's mental status and developed a revised treatment plan in collaboration with the treatment team.

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VI. Witnesses and Statements

• Nurse Sarah Johnson: "Mr. Doe's behavior escalated rapidly during the session, posing a risk to himself and others. Immediate intervention was necessary to ensure the safety of everyone involved."

• Therapist Michael Smith: "Despite attempts to de-escalate, Mr. Doe's behavior became increasingly hostile, requiring intervention by clinic security to prevent further harm."

• Therapist Assistant Emily Brown: "Our priority was to ensure the safety of all patients in the room. I escorted them to a secure area while security addressed the situation with Mr. Doe."

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VII. Documentation and Signatures

This incident report was completed by Nurse Sarah Johnson (Staff ID: 6789) on May 20, 2050, and reviewed by Clinic Administrator Dr. Jessica Martinez (Administrator ID: 0123). All staff involved have reviewed and signed this report electronically.

Nurse Sarah Johnson (Signature):                               

Dr. Jessica Martinez (Signature):                               

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