Get Alameda County Ems Unusual Occurrence Form - Acphd

Filling out the Alameda County EMS Unusual Occurrence Form is an important process for documenting any unusual incidents that occur during emergency medical services. This guide will provide you with clear and detailed instructions on how to complete the form online effectively.

Follow the steps to accurately complete the form online

1. Press the ‘Get Form’ button to obtain the form and open it in your document editor.
2. Begin by entering the Patient ID and CMED/Agency Incident number at the top of the form. Ensure that the information is accurate and corresponds to the specific incident you are reporting.
3. Fill in the title and agency fields. This section helps identify who is submitting the report.
4. If you would like to receive confirmation from EMS regarding the receipt of this form, check the appropriate box.
5. Enter the date and time of the occurrence to provide context for the incident.
6. Record your unit number, the name of the person initiating the report, and the location of the occurrence.
7. List any other individuals involved in the incident by including their names, titles, and agencies.
8. Document any witnesses to the incident, providing their names, titles, departments, and how they are related to the occurrence.
9. In the 'Nature of Occurrence' section, check all appropriate boxes that describe the incident. Each option has specific definitions provided on the back of the form if further clarification is needed.
10. If applicable, attach the Patient Care Report (PCR) to this form. Note that certain occurrences may necessitate immediate notification to EMS.
11. Provide detailed observations and facts regarding the occurrence in the 'Details of Occurrence' section. Be clear and comprehensive, and consider using an addendum if more space is required.
12. Indicate whether this event could cause a community reaction or pose a threat to public health and safety. If yes, provide the name and time of who you contacted in EMS about this concern.
13. Detail any immediate efforts made to resolve the issue following the occurrence.
14. Complete the report by providing your signature and the date and time of completion. Be sure to indicate if a PCR is attached.
15. In the investigator section, document the level of severity according to the definitions provided. Specify the investigation outcome and actions taken.
16. Finalize the EMS review section by noting the date notified, who reviewed it, and any final determinations or comments.
17. Once you have filled out the form completely, you can save your changes, download a copy for your records, print if necessary, or share the document as required.

Take the next step in ensuring accurate documentation by completing the Alameda County EMS Unusual Occurrence Form online today.