Get Instructions For Completing The Incident Report Instructions ... - Esrdnetwork

Completing the Incident Report for the Texas Department of State Health Services is a crucial process in documenting incidents within a healthcare facility. This guide will provide clear instructions to help users fill out the report accurately and efficiently.

Follow the steps to effectively complete your incident report.

1. Press the ‘Get Form’ button to access the incident report form online and open it in your preferred editing tool.
2. In the Reporting Information section, indicate the nature of the reportable incident by checking the appropriate box. Record the date of the report and the date and time of the incident, ensuring to circle 'am' or 'pm'.
3. Fill in the Facility Information section by entering the facility license number, provider number, facility name, address, as well as the contact person’s details, including phone number, email, and fax.
4. In the Summary section, provide a concise overview of the incident. Outline what occurred, identify those involved, and describe the immediate actions taken in response to the incident.
5. Compose a detailed Narrative report that describes how the incident was managed and what preventive measures might be implemented to avoid similar occurrences in the future.
6. In the Action section, check all applicable actions that will be taken following the incident, such as staff education or policy revisions.
7. Complete the Patient Information section if the incident involves a patient. This includes the patient’s name, date of birth, dialysis start date, admission date, and current condition.
8. Fill out the Treatment Information section with the type of service provided and access type used. Complete the necessary charts regarding treatment details and attach copies of the last three treatment sheets.
9. If applicable, complete the Patient Transfer section, indicating the receiving facility and transfer date, along with any additional required documentation.
10. Conclude by signing and dating the report, including your printed name and title. Ensure the incident report is returned via fax or mail as directed, without placing any information in the 'DSHS Use Only' section.
11. Once all information is complete, save changes, download, print, or share the form as necessary.

Ensure your forms are accurately completed online for swift processing of your incident reports.