Physical Therapy Medical Incident Report
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