Get Ca Cal Ema 2-920 2003

The CA Cal EMA 2-920 form is a critical document for reporting suspicious injuries and is designed for law enforcement use. This guide will provide clear and supportive instructions to assist you in completing this form online effectively.

Follow the steps to fill out the CA Cal EMA 2-920 online.

1. Click the 'Get Form' button to obtain the form and open it in the editor.
2. Begin with Part A by entering the patient's name in the designated fields, including last name, first name, and middle name.
3. Provide the patient's birth date in the appropriate field.
4. Indicate the patient's gender by selecting 'M' for male or 'F' for female.
5. Enter the patient's residing address, ensuring to write the street number and name without using a P.O. Box.
6. Include a safe phone number where the patient can be reached.
7. Specify the language the patient speaks, checking the box for 'Y' for English or providing another language if necessary.
8. Record the date and time of the injury; if unknown, check the designated box.
9. If available, include the location or address where the injury occurred.
10. Document any comments from the patient regarding the incident, including details about the suspect or witnesses.
11. If the patient identified a suspect, write down their name in the appropriate field.
12. Specify the relationship of the suspect to the patient, if any.
13. Provide a brief description of the suspicious injury, including physical findings and the final diagnosis.
14. In Part B, list the law enforcement agency that was notified by phone, as mandated.
15. Indicate the date and time when the report was made to the law enforcement agency.
16. Record the name of the individual who received the phone report.
17. List the job title of the person receiving the report.
18. Document the phone number of the law enforcement agency involved.
19. In Part C, write down the employer's name and their contact number.
20. Include the employer's address with the street, city, state, and zip code.
21. Record the name of the health practitioner filing the report.
22. List the job title of the health practitioner.
23. Sign the form using the health practitioner's signature.
24. Finally, input the date of signature and ensure all information is correct before submission.
25. Users can now save any changes made, download, print, or share the completed form as needed.

Complete your CA Cal EMA 2-920 form online today to ensure proper reporting of suspicious injuries.