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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