Follow the steps to complete your report online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by filling out Part A: Patient with Suspicious Injury. Input the patient's name in the designated field, including the last, first, and middle names.
3. Enter the birth date of the patient. This information helps identify the individual accurately.
4. Indicate the patient's gender by selecting the appropriate option. This may help contextualize the injury.
5. Provide the patient's residing address. Ensure that you fill in the complete address, including number and street, without using a P.O. Box.
6. Record a safe phone number for the patient. Ensure this is the number where the patient can be reached safely.
7. Fill in the date and time of the injury. If unknown, check the provided box.
8. Detail the location or address where the injury occurred, if available. This information is essential for further investigations.
9. In the patient's comments section, include any relevant information about the incident and individuals involved.
10. If applicable, specify the name of the suspect as identified by the patient, along with their relationship, if any, to the patient.
11. In the suspicious injury description, provide a brief overview of the physical findings and final diagnosis.
12. Proceed to Part B, listing the law enforcement agency notified by phone, along with the date and time the report was made.
13. Enter the name and job title of the person who received the report, as well as their phone number.
14. In Part C, fill out the employer’s name, phone number, and address to identify the source of the report.
15. Input the name of the health practitioner who is filing the report, along with their job title.
16. Ensure the health practitioner signs the report electronically, followed by the date of signing.
17. Review all entered information for accuracy. Once confirmed, you can save changes, download the report, print a copy, or share it as necessary.

Complete your Suspicious Injury Report California online today to ensure timely and accurate documentation.