Care critical incident report 2025

1. Click ‘Get Form’ to open the care critical incident report in the editor.
2. Begin by filling in your name, date reported, and contact information in the 'Reporter Name' section. This ensures that your report is traceable.
3. In the 'REPORTER SOURCE' section, select your organization type by checking the appropriate box. This helps categorize the source of the report.
4. Provide details about your relationship to the member in the 'Relationship of Reporter' field. This context is crucial for understanding the perspective of the reporter.
5. Fill out 'MEMBER INFORMATION' with relevant details such as last name, first name, and member ID. Accurate member information is essential for proper follow-up.
6. In 'CRITICAL INCIDENT INFORMATION', enter dates and location of the incident. Select a critical incident code/category that best describes what occurred.
7. Provide a brief description of the incident, including key details like who was involved and what happened. Clarity here aids in effective resolution.
8. Finally, ensure you complete any additional fields regarding resolution or confirmation before submitting your form to CI@lacare.org.

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