MIRF REPORT
Request:
MEDICAL
Campus:
Vista
Location/Building:
[68]
Date of Incident:
October 5, 2019
Time of Incident:
5:40 PM
Number of Patients for this Incident:
[75]
List Patient(s) Name, Age, Parent/Guardian (if under 18),… :
JAXON BURRELL, 8 Y/ O MAKE FELK ABD HIT HEAD ON FOOS BALL TABLE. SMALL. HEMATMA TO RT FOREHEAD. NO LOC. AKERT AND ORIENTED TO PERSON, PLACE AND EVENT. NO HEADACHE. BLURRED VISION, NAUSEA OR VOMITING, ICE VAG APPLIED.
Describe Medical Event:
AS ABOVE. PARENTS PH NUMBER 750 737 4777. PARENTS AWARE PER CHILD CARE.
Actions Taken by Team Members:
[79]
Number of NCSM Team Members Involved:
[81]
List Name(s) of NCSM Team Members Involved:
1
Was medical attention accepted?”:
Yes
Medical attention was refused by (name and relationship to… :
Was 911 emergency service called?:
No
Was patient transported via 911 emergency services?:
No
What hospital was victim transported to?:
Palomar
NCS team lead:
[249]
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