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

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