Follow the steps to complete the AZ PM Form 7.4.1 online.

1. Click 'Get Form' button to access the form and open it in your preferred editing platform.
2. Identify the behavioral health facility information. Fill in the fields for facility name, license number, subclass, and tracking ID.
3. Provide the behavioral health facility's address and phone number in the designated section.
4. Select the type of report being filed by checking all applicable boxes for incidents or accidents, ensuring to include necessary details for each category.
5. Complete the section regarding the enrolled member or non-enrolled behavioral health recipient involved in the incident, inputting name, address, date of birth, and other relevant data.
6. Fill in the incident details, including the date and time, address, provider name, and provider address.
7. Document the description of the incident, detailing the events leading up to and the condition of the individual before and after the incident.
8. In the 'Medical Services' section, answer questions related to who provided immediate attention and any medical services administered, including details about hospital admissions if applicable.
9. Ensure the clinical director or designee reviews the incident documentation. This section must be completed and signed for processing.
10. Once all sections are completed, save your changes. You can also choose to download, print, or share the filled form as necessary.

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