Get Sentinel Event Report Form (part 2) - Health Nv 2020-2025

Completing the Sentinel Event Report Form (part 2) is essential for documenting significant events within medical facilities. This guide provides clear, step-by-step instructions to assist users in accurately filling out the form online.

Follow the steps to complete the report effectively.

1. Press the ‘Get Form’ button to acquire the form and open it in your preferred online editor.
2. Enter the date of the sentinel event in the designated field, using the format YYYYMMDD for consistency.
3. Input the registry number provided for the event, recording it carefully.
4. Fill out the facility information section by entering the facility license number and name accurately.
5. Specify the report completed by field with the last name, first name, and middle initial of the individual completing the form.
6. Document the date when the facility completed Section II of the form using the YYYYMMDD format.
7. In the primary contributing factor(s) section, check up to four boxes that align with the issues contributing to the sentinel event. Consider patient-related, staff-related, environmental, communication, and technical factors.
8. Next, identify the contributing department(s) by checking a maximum of four relevant boxes reflecting the departments involved in the event.
9. In the corrective actions section, select all applicable actions taken in response to the event to ensure proper documentation.
10. Provide any lessons learned and additional information or comments that may assist in understanding the event or actions taken.
11. Upon completion, you may save your changes, download the form, print it for your records, or share it as needed.

Take action now by completing and submitting your documents online.