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Adverse Incident Report Form
Fax to: 8889770776
For Tufts Health Unify, fax to: 8573046304Todays date//Please type or print legibly and fax on the day of the incident.
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What is adverse incident report form?
The adverse incident report form is a document used to report any unexpected or unusual events or situations that have resulted in harm or could have resulted in harm to a person.
Who is required to file adverse incident report form?
Healthcare providers, facilities, or individuals who have knowledge of an adverse incident are required to file the adverse incident report form.
How to fill out adverse incident report form?
The adverse incident report form should be filled out with detailed information about the incident, including the date, time, location, persons involved, and a description of what happened.
What is the purpose of adverse incident report form?
The purpose of the adverse incident report form is to document and investigate adverse events in order to prevent similar incidents from occurring in the future.
What information must be reported on adverse incident report form?
Information such as date and time of incident, location, individuals involved, description of incident, and any contributing factors must be reported on the adverse incident report form.
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