Follow the steps to successfully complete the burn injury report.

1. Click ‘Get Form’ button to access the IA DPS Burn Injury Report and open it in the editor.
2. Begin by filling in the patient’s full name, contact number, and their complete address, including city, county, and state where the individual resides.
3. Indicate the city and street address where the burn incident occurred. Accurately recording this information is essential for the report.
4. Select the patient's gender from the available options. Additionally, enter the patient’s date of birth accurately.
5. In the area(s) of body injured section, mark all relevant regions affected by the burn injury. Be thorough to ensure proper documentation.
6. Provide the initial burn estimate, along with the 12+ hour and 24+ hour burn estimates, ensuring to document percentage of burn for 1st, 2nd, and 3rd degree burns.
7. Check any boxes that apply regarding the injury, such as whether airway burns occurred or if the burns compromised vision.
8. In the toxicology section, note any admitted drug use or alcohol testing results where applicable.
9. For the causes of burn injury, check all applicable options and provide descriptions for any chemical, electrical, or explosion-related incidents.
10. Fill in the reporting facility name, address, city, and zip code, as well as the attending physician’s name.
11. Complete the reporting person section, including the date the report is being made.
12. Once all fields are filled out, you can save your changes, download the completed document, print it, or share it as necessary.

Complete your IA DPS Burn Injury Report online now to ensure proper reporting.