Get Special Incident Breportb Form - San Diego Regional Center - Sdrc

Filling out the Special Incident Report Form for the San Diego Regional Center is a critical process for documenting incidents involving individuals in care. This guide provides step-by-step instructions to help you complete the online form accurately and efficiently.

Follow the steps to fill out the Special Incident Report form online.

1. Click ‘Get Form’ button to access the form and open it in your editing tool.
2. Begin by completing the 'Confidential Client Information' section. Enter the consumer’s name, unique identification number (UCI), age, gender, date of birth, date of incident, time of incident, and date of admission to the facility.
3. Indicate the location of the incident by selecting one or more options from the list provided, such as 'Home of Family/Consumer' or 'Consumer’s Residence.' You should also specify the name of the place where the incident occurred.
4. Move to 'Section II' and select the type of special incident. For instance, check off if it involves a death, missing person, or any form of suspected abuse. Be detailed to ensure all relevant incidents are captured.
5. In 'Section III', provide a description of the incident. Include specifics about the conditions leading up to the incident and the people involved.
6. If applicable, describe the alleged perpetrator’s information and the relationship to the consumer.
7. Document any medical treatment provided to the consumer, including the nature and location of treatment.
8. Record actions taken by the vendor in response to the incident, along with plans for preventing further occurrences.
9. List any parties or agencies that were notified regarding the incident, including names and contact information.
10. Complete the 'Report Written By' section with the writer's name, title, and signature, noting the reviewer's information as well.
11. Review all sections for accuracy, then save your changes. You can download, print, or share the completed form as necessary.

Start filling out the Special Incident Report form online today.