Get Maine Sentinel Event Notification And Near Miss Reporting Form - Maine

This guide provides a clear and supportive approach to filling out the Maine Sentinel Event Notification And Near Miss Reporting Form online. The purpose of this form is to report significant events or near misses in healthcare settings, ensuring accountability and enhancing patient safety.

Follow the steps to effectively complete the reporting form.

1. Press the ‘Get Form’ button to access the Maine Sentinel Event Notification And Near Miss Reporting Form, and open it in your preferred online editor.
2. Enter today's date in the designated field. This is important for tracking when the report was completed.
3. Indicate what type of event is being reported by selecting either 'Sentinel Event' or 'Near Miss' by checking the appropriate box.
4. Fill in the date of discovery, date of the event, and the time of the event. Be sure to specify AM or PM.
5. If applicable, provide the date of death in the designated field.
6. Specify the patient's age and gender by choosing 'M' or 'F' from the provided options. Include the admitting diagnosis of the patient.
7. In the description box, briefly describe the event, including its location. This should include all relevant details.
8. Select all types of events being reported from the list provided. This includes options such as 'Unanticipated Death' and 'Suicide within 48 Hours of Discharge.'
9. Answer the yes/no questions regarding unanticipated death or significant loss of function within 48 hours, as well as whether the event requires further evaluation.
10. Indicate if an autopsy was requested or performed, and whether the Medical Examiner was contacted and accepted the case.
11. If applicable, note if any equipment was sequestered by answering yes/no and providing any necessary details.
12. Provide your details as the reporter, including name, title, telephone number, email address, and facility name.
13. Once all sections of the form are completed, ensure to save any changes you have made. You can then download, print, or share the form as necessary.

Complete your reporting forms online today for timely and efficient submission.