Get E16 Category Green Card

Completing the E16 Category Green Card online is a crucial process for submitting important information. This guide provides clear, step-by-step instructions to assist users in filling out the form accurately and efficiently.

Follow the steps to complete the E16 Category Green Card online.

1. Click ‘Get Form’ button to access the E16 Category Green Card and open it in your preferred format for editing.
2. In the first section, enter the facility name where the incident occurred. This should be the full name of the facility responsible for the resident care.
3. Proceed to input the resident's name as indicated on their official documents. Ensure accuracy to avoid any discrepancies in reporting.
4. Fill in the resident's sex by checking the appropriate box. This section is important for demographic accuracy.
5. Provide the birthdate of the resident in the format mm/dd/yyyy to maintain consistency and clarity in records.
6. Indicate the acuity level at the time of the incident by selecting the appropriate category: SNF, ICF, ICF/MR, or Other. Choose based on the resident's condition.
7. List the diagnosis(es) of the resident related to the incident. Providing detailed information is essential for a comprehensive report.
8. Record the date and time when the incident occurred. This information is critical for tracking and analysis purposes.
9. Specify the place of the incident, such as a hallway, bedroom, or dining area. Clear information helps in understanding the context of the incident.
10. In the description section, provide a detailed account of the incident. Ensure to include all relevant facts and observations as this information is vital.
11. Describe the kind and extent of medical intervention provided, if any. Include information on diagnostic tests and medical assessments for thorough documentation.
12. Detail any corrective actions taken in response to the incident. This reflects the facility's responsibility in addressing issues.
13. Indicate if the incident has been reported to other agencies, such as APS or DOH. Select 'Yes' or 'No' and provide the names of the agencies if applicable.
14. Complete the reporter's name and title in the designated field, followed by their signature and the date of reporting.
15. If no reportable incidents have occurred in the facility for the specified reporting period, check the appropriate period boxes and fill in the necessary reporter information. Ensure to submit by the respective deadline.
16. After completing all sections, ensure to review the form thoroughly. Save the changes, download for your records, print it for submission, or share with the necessary parties.

Ensure all your documentation is processed smoothly by completing your forms online today.