Get 14-day Sentinel Event Report Form - Nevada Board Of Medical - Medboard Nv

Filling out the 14-Day Sentinel Event Report Form is essential for reporting sentinel events in accordance with Nevada regulations. This guide provides a clear overview of the steps needed to complete the form accurately and effectively.

Follow the steps to successfully complete the report form.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Enter the date of the sentinel event in the provided fields, ensuring to use the format MM/DD/YYYY.
3. Fill in today's date in the 'Date of Report' section using the same MM/DD/YYYY format.
4. Indicate the patient's county of residence in Nevada and their state or country of residence if not in Nevada.
5. Provide the patient's date of birth in the format MM/DD/YYYY.
6. Select the patient's gender by marking either 'Male' or 'Female.'
7. Indicate whether the sentinel event occurred in a practice office by selecting 'Yes' or 'No.'
8. If 'No' is selected, specify the type of facility where the event occurred, ensuring it complies with reporting guidelines.
9. List the primary and secondary specialties of the physician who performed the surgery or procedure.
10. Provide a detailed description of the sentinel event and the surgery or procedure that was being performed.
11. Describe the outcome of the sentinel event, particularly noting any cases of death, permanent injury, or psychological injury.
12. Specify any corrective actions taken, including repairs to equipment or modifications to procedures, policies, or processes.
13. Sign and date the form in the designated area. Each reportable sentinel event requires a separate form, and a signature is mandatory.
14. Once completed, save your changes, and consider options to download, print, or share the form as necessary.

Complete your document online to ensure timely reporting of sentinel events.