Get Bcal-4607-fillable

The BCAL-4607-Fillable is a crucial document for reporting incidents and accidents in facilities regulated by the Michigan Department of Human Services. This guide provides clear, step-by-step instructions to help users complete the form efficiently and accurately.

Follow the steps to successfully complete the BCAL-4607-Fillable online.

1. Click the ‘Get Form’ button to access the document and open it in your online editor.
2. Fill in the date received and date reviewed at the top of the form to track the submission timeline.
3. Select the appropriate action taken by checking one of the options for follow-up. Choose 'No Follow-Up Needed,' 'Phone Call Follow-Up,' or 'SI Opened.'
4. Provide information about the facility or home by entering the name, license number, address, and contact details.
5. Identify the person directly involved in the incident by entering their name and selecting their role as a resident, employee, or visitor.
6. If there are other individuals involved or witnesses, include their names and select their corresponding roles.
7. Detail the facts of the incident, including the date, time, location, and a description of what occurred. Be thorough in explaining any injuries.
8. Record any actions taken by staff and treatment provided. Attach additional sheets if necessary.
9. Outline any corrective measures taken to prevent future incidents, also attaching supplementary pages if needed.
10. Provide information about the treating physician or medical facility, including contact details and the date and time care was given.
11. List all persons notified regarding the incident, including agencies, their notification dates, and whether written notice was provided.
12. Sign the report in the designated signatures section. Include the print name, title, and date of the person completing the report, as well as the licensee or administrator's signature.
13. Once completed, save your changes, and consider downloading, printing, or sharing the form as needed.

Complete the BCAL-4607-Fillable and ensure proper documentation of incidents online today.