Get Ca Cal Ema 2-920 2009-2025

Filling out the CA Cal EMA 2-920 form correctly is crucial for effective reporting of suspicious injuries. This guide will walk you through each section of the form in a clear and supportive manner to ensure accurate completion.

Follow the steps to complete the form accurately.

1. Click the ‘Get Form’ button to acquire the CA Cal EMA 2-920 form and open it in your editing tool.
2. In Part A, enter the patient’s name in the fields provided, including the last name, first name, and middle name as applicable.
3. Fill in the patient’s birth date to accurately reflect their age.
4. Indicate the patient’s gender by selecting the appropriate option.
5. Provide the patient’s residing address, ensuring to avoid using a P.O. Box.
6. Record the patient’s safe phone number for contact purposes.
7. Select if the patient speaks English. If not, identify another language spoken.
8. Fill in the date and time of the injury. If unknown, be sure to check the appropriate box.
9. Describe the location or address where the injury took place, if available.
10. Document any comments the patient has about the incident, including information about any alleged suspects.
11. If the patient identifies a suspect, include their name in the designated section.
12. Outline the relationship between the patient and the suspect, if applicable.
13. Provide a brief description of the suspicious injury, including physical findings and any diagnosis.
14. In Part B, record the law enforcement agency that was notified by phone, following the mandated requirements.
15. Enter the date and time the report was made to the agency.
16. Include the name of the person who received the phone report along with their job title.
17. Fill in the contact number for the law enforcement agency.
18. Enter the agency receiving the written report as mandated.
19. Document the agency incident number associated with the report.
20. In Part C, provide the employer’s name and contact number.
21. Include the employer’s address in the provided fields.
22. List the name of the health practitioner completing the report.
23. State the job title of the health practitioner.
24. Have the health practitioner sign the form in the designated area.
25. Finally, fill in the date the form was signed.
26. Once all sections are complete, save changes, and then download, print, or share the completed form as needed.

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