Get Vshp Choices Critical Incident Form

Filling out the VSHP CHOICES Critical Incident Form online is a vital step in ensuring a comprehensive report of any incidents that occur in home and community-based settings. This guide will walk you through each section of the form to facilitate accurate and efficient completion.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to obtain the VSHP CHOICES Critical Incident Form and open it for editing.
2. Enter today’s date and time at the top of the form to indicate when you are filing the report.
3. Fill in the member's name along with their date of birth to identify the individual involved in the incident.
4. Detail the incident specifics by providing the date, time, and location of the incident. Ensure that the address includes the city, state, and ZIP code for clarity.
5. Include the member's contact numbers and indicate whether back-up services are required for the individual.
6. List the provider involved in the incident, as well as details about individuals associated with the incident. Make sure to include names, relationships, and contact information.
7. Indicate whether Emergency Medical Services (EMS), Adult Protective Services (APS), or law enforcement were contacted, providing their names and phone numbers as needed.
8. If applicable, provide details about medication errors, including medication name, prescribed dosage and frequency, and the incident dosage and frequency.
9. Write a clear narrative outlining the incident, focusing on who was involved, what happened, where and when it occurred, and how it unfolded.
10. Document any corrective actions taken, including follow-up measures and reassignment details if caregiver changes were made.
11. Review all entered information for accuracy before finalizing the form.
12. Once completed, save changes, and then proceed to download, print, or share the form as necessary.

Complete the VSHP CHOICES Critical Incident Form online today to ensure accurate incident reporting.