LAC-DMH Incident Reporting Form - lacdmh lacounty 2025

1. Click ‘Get Form’ to open the LAC-DMH Incident Reporting Form in the editor.
2. Begin by entering the client's name, date of birth, and provider number in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the incident details including the incident date, location, and time. This section helps provide context for the report.
4. Indicate the diagnosis and list all current medications along with their dosages. This information is vital for understanding the client's treatment history.
5. Select the appropriate clinical incident type by checking the corresponding box. Be sure to review each option carefully to ensure accurate reporting.
6. In the description section, provide a detailed account of the incident. If necessary, use an additional sheet while ensuring it includes any required disclaimers.
7. Complete the family awareness section and include contact information if applicable. This ensures that all relevant parties are informed.
8. Finally, sign and date the report before mailing it to the specified address within one business day. Remember to keep a copy for your records.

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