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PA PSRS-248-2 2014-2026 free printable template

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1222 Commonwealth of Pennsylvania Public School Employees' Retirement System 5 N 5th Street Harrisburg PA 17101-1905 Toll-free: 1.888.773.7748 www.psers.state.pa.us Fax: 717.772.3860 Mail Center POA
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Begin with the header section, providing your name, contact information, and the date.
02
Fill in the patient’s information including their name, date of birth, and hospital or facility details.
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In the 'Incident Description' section, clearly describe the nature of the incident that occurred.
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Include the date and time of the incident as well as the names of any witnesses.
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Accurate details about the location of the incident must be filled in to provide context.
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In the 'Action Taken' section, document any immediate actions taken regarding the incident.
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Review all entered information for accuracy and completeness before signing and dating the form at the bottom.

Who needs PA PSRS-248-2?

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Healthcare professionals who are required to report patient incidents or adverse events.
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Administrators in medical facilities that must maintain compliance with reporting regulations.
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Patients or their representatives who wish to document incidents for formal review.
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PA PSRS-248-2 is a form used in Pennsylvania for reporting certain data concerning public school employee retirement.
Employers who participate in the Pennsylvania Public School Employees' Retirement System (PSERS) are required to file PA PSRS-248-2.
The PA PSRS-248-2 must be filled out by providing accurate employee information, including the employee's name, Social Security number, employment dates, and compensation details, following instructions provided with the form.
The purpose of PA PSRS-248-2 is to collect essential data to administer benefits and manage retirement contributions for public school employees.
The information that must be reported includes the employee's personal details, employment history, contribution amounts, and any applicable leave or retirement status.
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