Get Qi-705 Attachment Bhi Critical Incident Form - Behavioral ... - Bhicares

Filling out the QI-705 Attachment BHI Critical Incident Form is a crucial process for documenting significant events in behavioral healthcare. This guide will walk you through each section of the form to ensure it's completed accurately and thoroughly.

Follow the steps to effectively complete the form.

1. Press the ‘Get Form’ button to access the form and open it in your online document editor.
2. Begin with the 'Member Information' section. Enter the member's name in the 'Member Name' field, specifying their first and last names. Make sure to check for any typos to ensure accuracy.
3. In the 'Agency Information' section, list the reporting agency accurately. This information is essential for identification and tracking purposes.
4. Provide the 'Medicaid ID' for the member. Ensuring this ID is correct is crucial for any further actions regarding the incident.
5. Fill in the name of the reporting person, including their first and last name in the designated fields. This identifies the individual responsible for submitting the form.
6. Input the reporting person's phone number to ensure they can be reached for any follow-up questions.
7. Enter the member's date of birth in the appropriate format. This information is necessary for verifying the member’s identity.
8. Indicate the date of the incident clearly. Accurate dates are important for assessing timelines and responsibilities.
9. Specify the title of the reporting person. This identifies their role in relation to the incident and the agency.
10. Select the appropriate category of critical incident from the provided list. This helps in categorizing the nature of the incident effectively.
11. Provide details regarding the notification of the incident. List any relevant notifications including the names, dates, and times when the incident was reported.
12. In the incident description section, provide a clear and detailed account of the incident, including the involved staff member(s), outcomes, and actions taken by the facility to prevent recurrence.
13. After completing all fields, review the form for any omissions or errors. It’s important to ensure all required information is filled out correctly.
14. Finally, you can save your changes, download, print, or share the completed form as necessary.

Complete your critical incident reports efficiently online today.