Get Mn Serious Injury Report 2023-2025

The MN Serious Injury Report is an essential document for reporting serious injuries related to clients under care in various facilities. This guide provides step-by-step instructions to assist users in accurately completing the form online.

Follow the steps to effectively fill out the MN Serious Injury Report online.

1. Press the ‘Get Form’ button to obtain the MN Serious Injury Report and open it in your preferred editor.
2. Begin by filling out the client information section. Provide details such as the first name, middle initial, last name, and client facility name (if applicable). Select the gender, and indicate the date of birth. Choose the appropriate ethnicity from the available options.
3. Next, fill in the county of residence and the county of financial responsibility. Specify the address type (temporary or permanent) and provide the full address, including apartment/suite number, city, county, state, and zip code.
4. In the client home number section, provide the phone number and indicate whether a message can be left. Repeat this process for the client mobile number.
5. Move on to the reporter information section. Indicate whether you wish to keep your identity private and if you have concerns about retaliation. Fill in your first name, last name, title, agency/program name (if applicable), and your email address. Complete your address details and contact number, including whether messages can be left.
6. Indicate who else you reported the injury to by checking all applicable options, which may include administration, legal representatives, and various agencies.
7. In the additional client information section, check all categories that apply to the client, legal representatives, and legal statuses.
8. In the serious injury information section, fill out the date and time of the injury if known. Specify whether the injury occurred at the client’s residence. If not, enter the relevant agency, facility, or program details where the injury occurred.
9. Select the location where the serious injury occurred by checking the corresponding box.
10. In the injury type section, select the type of injury that applies. Complete the circumstances surrounding the serious injury by checking all relevant options.
11. Provide a detailed description of how the serious injury occurred, the medical attention received, any medication changes, follow-up appointments needed, and updates to the abuse prevention plan or individual programming.
12. Complete the diagnostic information and medications sections. If necessary, attach any supporting documentation.
13. Finally, review your entries for accuracy. After ensuring all sections are completed, save the changes, and choose to download, print, or share the form as needed.

Complete the MN Serious Injury Report online to ensure timely and accurate reporting.