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INFANT/CHILD INTAKE FORM PATIENT Informational / / p Child's Name LAST FIRST MI Sex Male Revalidate of Birth / / Age Height Weight lbs. Address City State Zip Parent/Guardian Name(s) Cell Phone ()

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How to fill out in case of emergncy

01

Stay calm and assess the situation.

02

Call emergency services (e.g. 911) if necessary.

03

If it is safe to do so, provide first aid or medical assistance to the injured person.

04

Follow any emergency procedures or protocols established by your workplace or organization.

05

Cooperate with emergency responders and provide them with necessary information.

06

Evacuate the area if instructed to do so.

07

Remain at a safe location until the emergency situation is resolved.

08

Report the incident to relevant authorities or supervisors.

09

Document any details or observations related to the emergency for future reference or investigation.

10

Seek support or counseling if necessary to cope with the emotional impact of the emergency.

Who needs in case of emergncy?

01

Anyone who is directly affected by the emergency

02

Emergency responders and medical personnel

03

Co-workers or colleagues who can provide assistance

04

Family members or friends of the injured or affected person

05

Bystanders or witnesses who can provide relevant information

06

Employers or supervisors responsible for ensuring safety and response protocols

07

Community members or nearby residents who may be impacted by the emergency

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What is in case of emergency?

In case of emergency, individuals must follow the proper procedures and protocols to ensure safety and security.

Who is required to file in case of emergency?

Any individual or organization responsible for managing the emergency situation may be required to file a report.

How to fill out in case of emergency?

To fill out a report in case of emergency, individuals should provide detailed information about the situation, actions taken, and any individuals involved.

What is the purpose of in case of emergency?

The purpose of filing a report in case of emergency is to document and address the situation appropriately to prevent future incidents.

What information must be reported on in case of emergency?

Information such as the nature of the emergency, location, individuals involved, and actions taken must be reported in case of emergency.

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