Get Mfp Sentinel Event Reporting Form - Dch Georgia

Filling out the MFP Sentinel Event Reporting Form online is a crucial step in documenting critical incidents involving participants. This guide will provide you with clear, step-by-step instructions to ensure that the form is completed accurately and efficiently.

Follow the steps to fill out the MFP Sentinel Event Reporting Form online.

1. Click ‘Get Form’ button to access the form and open it for completion.
2. Begin by entering the date of the report in the designated text box. This is important for record-keeping purposes.
3. Fill in the waiver name or the name of the case manager/care or service coordinator as applicable.
4. Ensure to check if the case is for MFP CBAY by marking the corresponding box.
5. Input the participant's contact information, including their first name, last name, Medicaid ID number, date of birth, phone number, and address.
6. Specify the county where the participant resides.
7. If applicable, include the name and contact information of the provider involved in the incident.
8. Indicate the name and address of the inpatient facility where the participant was admitted, if relevant.
9. Record the date of the incident and the specific location where it occurred.
10. Select the type of critical incident or sentinel event from the list provided. Remember, each event requires a separate report.
11. Provide a brief summary of the event as well as detailed responses to the questions about the adverse outcomes, witnesses, actions taken, and plans for prevention.
12. Review the follow-up time frames for evaluating the effectiveness of processes implemented after the incident.
13. Document who was notified about the event, including their names and notification times.
14. Finally, enter the MFP field personnel's name, phone number, and email, followed by their signature.
15. Once completed, save the changes, download, print, or share the form as necessary, and ensure it is submitted to the appropriate coordinating agency.

Complete the MFP Sentinel Event Reporting Form online today to ensure timely and accurate reporting of incidents.