Action paputok injury reduction form 2026

1. Click ‘Get Form’ to open the action paputok injury reduction form in the editor.
2. Begin by entering the date when the form is accomplished. This is crucial for record-keeping.
3. Fill in the region where the hospital is located, followed by the name of the hospital or clinic submitting the report.
4. Input patient data: Last name, First name, and Middle name in their respective fields. If no informant is available, you may write 'Mr. X' or 'None'.
5. Provide the permanent address including House No., Street, Barangay, Municipality/City, and Province.
6. Enter contact details such as telephone number and check the appropriate box for sex (Male/Female).
7. Specify the patient's age in years, months, and days.
8. Record the date and time of injury using mm/dd/yyyy format and military time respectively.
9. Indicate where the injury occurred by checking Home, Street, or Other (specify).
10. Select whether the type of involvement was Active or Passive and specify nature of injury sustained.
11. If applicable, indicate if there were multiple injuries related to fireworks and provide diagnosis details.
12. Complete treatment information and disposition status before signing off on your entries.

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