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LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH REVISIONS ARE IN YELLOW HIGHLIGHT Revised 061616 CLINICALINCIDENT(EVENT)NOTIFICATION POLICY 303.05 PLEASE PRINT OR COMPLETE THIS ADMINISTRATIVE REPORT.
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Clinicalincident FAQ
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This form is to be used to report any incidents or concerns from eConsult or eTriage reports you have received. It enables our clinical development team to conduct an analysis of the event and recommend any changes to the system to reduce clinical risk if appropriate.
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Incident Report Form Checklist of the incident occurred. The form should include the date and time of the incident, as well as the names of all those involved. The form should also list the sequence of events, and describe any injuries and damage sustained, only the essential information of the incident happened.
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The form should be completed by the person involved in the accident or incident.
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The purpose of an incident report is to state the cause of the problem along with corrective actions that can be taken to minimise the risk of a future occurrence. The forms can also be used as safety documents, outlining potential safety hazards around the workplace.
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A clinical incident is an event or circumstance resulting from health care provision (or lack thereof) which could have or did lead to unintended or unnecessary physical or psychological harm to a patient.
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Incident reports should be completed immediately after a near miss, unexpected, awareness, or adverse events have occurred. This ensures that the involved individuals or witnesses can recall the details of the occurrence with clarity to fill the report form accurately.
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