MIRF REPORT
Request:
medical
Campus:
Vista
Location/Building:
[68]
Date of Incident:
July 9, 2023
Time of Incident:
11:00 AM
Number of Patients for this Incident:
[75]
List Patient(s) Name, Age, Parent/Guardian (if under 18),… :
isabel hernandez, 62f. 760-224-7080
Describe Medical Event:
abd pain, states feels like acid reflux.
Actions Taken by Team Members:
[79]
Number of NCSM Team Members Involved:
[81]
List Name(s) of NCSM Team Members Involved:
shane, lori, brad
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