PA PSRS-248-4 2019-2026 free printable template
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1201Commonwealth of Pennsylvania Public School Employees Retirement System 5 N 5th Street Harrisburg PA 171011905 Toll free: 1.888.773.7748 www.psers.state.pa.us Fax: 717.772.3860Mail Center POA Relationship
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How to fill out PA PSRS-248-4
01
Gather necessary information including patient details, incident specifics, and reporting facility information.
02
Access the PA PSRS-248-4 form on the official website or obtain a hard copy.
03
Fill in the patient’s identification details such as name, date of birth, and medical record number.
04
Describe the incident clearly, including date, time, and location.
05
Detail the circumstances surrounding the event, including what occurred and any injuries sustained.
06
Provide information about the healthcare personnel involved in the incident.
07
Indicate any follow-up actions taken after the incident, such as treatment or changes in procedure.
08
Review the completed form for accuracy and completeness.
09
Submit the form as per the instructions provided, either electronically or via mail.
Who needs PA PSRS-248-4?
01
Healthcare providers involved in patient care events or incidents.
02
Facilities that need to report patient safety incidents to the Pennsylvania Patient Safety Authority.
03
Administrators seeking to ensure compliance with state reporting regulations.
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Any staff member responsible for documenting patient safety events within a healthcare institution.
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What is PA PSRS-248-4?
PA PSRS-248-4 is a form used for reporting specific information related to the Pennsylvania Public School Employees' Retirement System (PSERS).
Who is required to file PA PSRS-248-4?
Employers participating in the Pennsylvania Public School Employees' Retirement System (PSERS) are required to file PA PSRS-248-4.
How to fill out PA PSRS-248-4?
To fill out PA PSRS-248-4, employers need to provide accurate information regarding employee contributions, service credits, and any other required data as specified in the form's instructions.
What is the purpose of PA PSRS-248-4?
The purpose of PA PSRS-248-4 is to collect essential data to assist in the administration and management of the retirement benefits for public school employees in Pennsylvania.
What information must be reported on PA PSRS-248-4?
Information such as employee identification, contribution amounts, service duration, and other relevant details concerning retirement benefits must be reported on PA PSRS-248-4.
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