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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