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Firearm Injury Report Form
State of Alaska, Section of Epidemiology
Per 7 AAC 27.013, health care providers are required to report all injuries caused by a firearm to the
Division of Public Health.
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How to fill out firearm injury report form
How to fill out firearm injury report form
01
Obtain the firearm injury report form from the appropriate agency or organization.
02
Provide your personal information such as name, address, date of birth, and contact details.
03
Describe the details of the firearm injury incident including date, time, and location.
04
Include information about the type of firearm involved and how it was obtained.
05
Provide details about the injuries sustained and any medical treatment received.
06
Include any additional information or witness statements related to the incident.
07
Review the completed form for accuracy and sign it before submitting it to the designated authority.
Who needs firearm injury report form?
01
Individuals who have sustained a firearm injury and are seeking medical treatment or legal assistance.
02
Law enforcement agencies investigating firearm-related incidents.
03
Medical professionals providing treatment to individuals with firearm injuries.
04
Firearm manufacturers or retailers involved in litigation related to firearm injuries.
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What is firearm injury report form?
The firearm injury report form is a document used to report injuries caused by firearms.
Who is required to file firearm injury report form?
Healthcare professionals, law enforcement agencies, and individuals who are involved in incidents related to firearm injuries are required to file the firearm injury report form.
How to fill out firearm injury report form?
To fill out the firearm injury report form, one must provide detailed information about the incident, the individuals involved, and the nature of the injuries.
What is the purpose of firearm injury report form?
The purpose of the firearm injury report form is to track and monitor firearm-related injuries for statistical analysis and to inform policies and interventions.
What information must be reported on firearm injury report form?
The firearm injury report form must include details such as the date and location of the incident, the type of firearm involved, the nature and severity of the injuries, and the demographics of the individuals affected.
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