Ca suspicious injury report 2026

1. Click ‘Get Form’ to open the California Suspicious Injury Report in the editor.
2. Begin with Part A: Patient with Suspicious Injury. Fill in the patient's name, birth date, and gender. Ensure accuracy as this information is crucial for identification.
3. Provide the patient’s residing address and a safe phone number where they can be reached. If applicable, indicate if the patient speaks English or another language.
4. Document the date and time of the injury, along with the location where it occurred. If unknown, check the appropriate box.
5. In section 9, include any comments from the patient regarding the incident, including details about potential suspects.
6. Complete Part B by noting which law enforcement agency was notified and provide relevant dates and times.
7. Finally, in Part C, fill out your employer's information and sign as a health practitioner to validate the report.

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