Free Medical Office Incident Report Template
Medical Office Incident Report
I. Incident Details
A. Date and Time of Incident:
May 15, 2050, 10:30 AM
B. Location of Incident:
Reception Area
C. Incident Description:
A patient became agitated while waiting for their appointment and started yelling at the receptionist, demanding to be seen immediately
II. Persons Involved
A. Patient Information:
|
Information |
Details |
|---|---|
|
Name: |
John Smith |
|
Date of Birth: |
January 10, 1985 |
|
Address: |
4743 Hill Street, Florida, OH 43545 |
|
Contact Number: |
555-123-4567 |
B. Staff Member Involved:
|
Information |
Details |
|---|---|
|
Name: |
Emily Johnson |
|
Position: |
Receptionist |
|
Department: |
Front Desk |
|
Contact Information: |
emily.j@email.com |
III. Witnesses
A. Witness 1:
|
Information |
Details |
|---|---|
|
Name: |
Sarah Smith |
|
Contact Information: |
sarah.smith@email.com |
B. Witness 2:
|
Information |
Details |
|---|---|
|
Name: |
David Brown |
|
Contact Information: |
david.brown@email.com |
IV. Incident Assessment
A. Severity of Incident:
Medium
B. Impact on Operations:
The incident caused disruption to the waiting area and created tension among other patients.
C. Immediate Action Taken:
The receptionist calmly attempted to de-escalate the situation and offered the patient a private space to discuss their concerns.
V. Recommendations
A. Preventive Measures:
-
Implement training sessions for staff on handling difficult situations and de-escalation techniques.
-
Consider installing panic buttons in the reception area for immediate assistance in similar situations.
B. Training Needs:
Provide additional training for all front desk staff on conflict resolution and customer service skills.
VI. Follow-Up Actions
A. Follow-Up Date:
May 20, 2050
B. Follow-Up Responsible:
Emily Johnson
C. Status Update:
Emily Johnson has completed the training module on conflict resolution and has reported feeling more confident in handling similar situations in the future.
VII. Attachments
-
CCTV footage of the incident
-
Incident log entry
For any further inquiries or updates regarding this incident report, please contact [Your Name] at [Your Email] or [Your Company Name] at [Your Company Email].
