MIRF REPORT
Request:
Head bump
Campus:
Vista
Location/Building:
[68]
Date of Incident:
January 19, 2020
Time of Incident:
11:45 AM
Number of Patients for this Incident:
[75]
List Patient(s) Name, Age, Parent/Guardian (if under 18),… :
Lomani Wong 4 years old
Describe Medical Event:
Child says she was outside on the preschool yard and was climbing near the wooden house, slipped and hit her head on the ground. Incident wasn’t witness but one of the volunteers found her. She was alert and oriented x 3 and crying. She states she is not in any pain. She has a 2×2 inch raised bump on the left side of her forehead. No bleeding. Ice applied x15 min. Mom called.
Actions Taken by Team Members:
[79]
Number of NCSM Team Members Involved:
[81]
List Name(s) of NCSM Team Members Involved:
Naomi Roth
Adrian
Greg Cantor
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?:
Other
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