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Event Description Hospital HEALTHCARE EVENT REPORTING FORM (HER), PATIENT INFORMATION FORM (PIF), AND SUMMARY OF INITIAL REPORT (SIR) 1.0 Type of Event 1.11.21.3A patient safety concern is reported
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To fill out hospital common formats v12, follow these steps:
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Gather all the necessary information and documents required for the form.
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Start by filling out the patient's personal information section, including their name, date of birth, address, and contact details.
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Provide the necessary details about the patient's medical history, such as previous illnesses, surgeries, allergies, and medications.
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Fill out the section for current symptoms or complaints, including the date of onset and any relevant details.
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Include any laboratory or diagnostic test results that are relevant to the current episode or condition.
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Fill out the section for physical examination findings, including vital signs, observations, and any relevant notes.
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Include any additional notes or comments that are relevant to the patient's condition or treatment.
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Review the filled-out form for accuracy and completeness before submitting it.
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If required, obtain the necessary signatures of the authorized medical personnel.
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Submit the completed hospital common format v12 form as per the hospital's procedures.

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Hospital common formats v12 is a standardized set of data elements used for reporting hospital quality measures.
All hospitals that are participating in quality reporting programs are required to file hospital common formats v12.
Hospital common formats v12 can be filled out electronically using the designated reporting tool provided by the quality reporting program.
The purpose of hospital common formats v12 is to collect and report data on hospital quality measures in a standardized format for comparison and analysis.
Hospital common formats v12 typically include data on patient demographics, diagnoses, treatments, outcomes, and other quality indicators.
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