MIRF REPORT

Request:
Fall

Campus:
Fallbrook

Location/Building:
[68]

Date of Incident:
March 26, 2023

Time of Incident:
10:00 AM

Number of Patients for this Incident:
[75]

List Patient(s) Name, Age, Parent/Guardian (if under 18),… :

Eddie Alvarez, 12 months, Nicola Vertongen, 858-353-6451

Describe Medical Event:

Fall with bump on middle forehead

Actions Taken by Team Members:
[79]

Number of NCSM Team Members Involved:
[81]

List Name(s) of NCSM Team Members Involved:

Paula

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?:

NCS team lead:
[249]


If any revisions or updates are needed to be made to this incident, complete the form below.
Please select a valid form