Medication incident and discrepancy report form 2025

1. Click ‘Get Form’ to open the medication incident and discrepancy report form in the editor.
2. Begin by entering the 'Error Date' and 'Discovery Date' at the top of the form. Ensure these dates are accurate as they are crucial for tracking incidents.
3. Fill in the 'Patient Information' section, including the patient's name, address, phone number, sex, date of birth, prescription number, and PHIN. This information is vital for identifying the patient involved.
4. Select the type of incident from the provided options. Indicate whether it was a medication incident or discrepancy by checking the appropriate boxes.
5. In the 'Incident/Discrepancy Description' section, provide a detailed account of what occurred. Be factual and concise to ensure clarity.
6. Complete the 'Contributing Factors' section by checking all relevant factors that may have contributed to the incident.
7. Document notifications made to both the patient and physician in their respective sections, ensuring you include dates and times.
8. Finally, sign and date where indicated at the bottom of the form to validate your report before submission.

Start using our platform today to streamline your medication incident reporting process for free!