Physical Therapy Medical Incident Report

I. Report Information

Field	Details
Reporter's Name:	[Your Name]
Report Date:	May 30, 2050

II. Incident Description

Field	Details
Incident Date:	May 29, 2050
Incident Time:	3:00 PM
Location:	Physical Therapy Room 2

III. Patient Information

Field	Details
Patient Name:	[Patient Name]
Patient Age:	[Patient Age]
Patient Contact Information:	[Patient Contact Information]

IV. Incident Details

• Description of Incident: The patient was undergoing a therapy session when they slipped and fell. The incident occurred as the patient was transitioning from one exercise to another and lost footing.

• Injury Sustained: The patient sustained a sprained ankle injury, which was promptly assessed by the attending therapist.

• Witnesses: [Witness Name]

V. Immediate Action Taken

• Action Taken by Staff: Immediate first aid was administered. The patient was then escorted to a more secure area, and the injury was documented. The patient was advised to seek further medical evaluation.

• Emergency Services Contacted: Yes

• Additional Notes: The attending therapist, Jane Doe, provided initial assessment and care. Emergency medical services arrived promptly and transported the patient to the hospital for further evaluation and treatment.

VI. Follow-Up

• Follow-Up Action Required: Schedule a follow-up appointment with the patient to assess recovery progress.

• Person Responsible: [Person Responsible]

• Follow-Up Date: June 5, 2050

VII. Sign-Off

Reported By: [Your Name]

Position: [Your Position]

Date: May 30, 2050

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