Get the free Washington State Firearm Injury Reporting System - doh wa

Washington State Firearm Injury Reporting System Note: This form is to be used for reporting all gunshot wounds treated in emergency departments. 1. Hospital name 2. Medical Record # 3. Patient name

How to fill out washington state firearm injury

Point by point instructions on how to fill out Washington State firearm injury form:

1. Begin by carefully reading the instructions given on the Washington State firearm injury form. Familiarize yourself with the purpose of the form and the information it requires.
2. Provide your personal details accurately. This includes your full name, address, phone number, and any other requested contact information. Make sure to double-check the accuracy of your information to avoid any potential errors.
3. Indicate the date and time of the firearm injury incident. Be as specific as possible, including the day, month, and year, along with the precise time the incident occurred.
4. Describe the circumstances of the firearm injury in detail. Explain how and where the incident took place, including any factors that may have contributed to the injury. Provide a clear and concise account of what happened.
5. If there were any witnesses to the firearm injury, provide their names, contact information, and a brief description of their involvement in the incident. Witnesses may be important for further investigation or verification purposes.
6. Specify the type of firearm involved in the injury. Include details such as the make, model, and any distinguishing features of the firearm. This information helps in documenting the specific weapon used.
7. Describe the type of injury sustained as a result of the firearm incident. Provide a detailed account of the injuries inflicted, and if there were any other individuals injured, list their names and injuries as well.
8. Attach any supporting documentation that may be required. This may include medical records, police reports, photographs of the incident, or any other relevant evidence that could assist in the investigation.

Who needs Washington State firearm injury form?

Any individual who has sustained or witnessed a firearm injury in Washington State may need to fill out this form. This includes victims, witnesses, or responsible parties involved in the incident. The form helps in documenting the incident, gathering necessary information, and ensuring that appropriate actions are taken. It is important to adhere to the state's regulations and procedures when it comes to firearm injuries, and the form serves as an official record and tool for reporting such incidents.

For pdfFiller’s FAQs

What is washington state firearm injury?

Washington state firearm injury refers to any injury caused by a firearm within the state of Washington.

Who is required to file washington state firearm injury?

Healthcare providers, hospitals, and other healthcare facilities are required to file washington state firearm injury.

How to fill out washington state firearm injury?

To fill out washington state firearm injury, healthcare providers must report the necessary information on the designated form provided by the Washington State Department of Health.

What is the purpose of washington state firearm injury?

The purpose of washington state firearm injury is to track and monitor firearm-related injuries in the state to inform public health interventions and policies.

What information must be reported on washington state firearm injury?

Information such as the type of injury, location, date, time, and circumstances of the firearm injury must be reported on washington state firearm injury.

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