MIRF REPORT

Request:
Medical – head pain

Campus:
Vista

Location/Building:
[68]

Date of Incident:
December 12, 2021

Time of Incident:
12:00 PM

Number of Patients for this Incident:
[75]

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

Adley Horton – 8

Shannon and Ray Horton – 7605250926

5/10 – dull pain

Applied 2nd ice pack.

Fell, and a fellow classmate stepped on the R side of his head behind his R ear.

Erin Cobos – 2nd/3rd grade volunteer applied 1st ice pack.

Describe Medical Event:

5/10 – dull pain

Applied 2nd ice pack.

Asked how many fingers am I holding up. Stated the correct amount – 3.

1110: child stated pain is subsiding.

Actions Taken by Team Members:
[79]

Number of NCSM Team Members Involved:
[81]

List Name(s) of NCSM Team Members Involved:

Bryan Hall, Erin Cobos

Was medical attention accepted?”:
Yes

Medical attention was refused by (name and relationship to… :
N/A

Was 911 emergency service called?:
No

Was patient transported via 911 emergency services?:
No

What hospital was victim transported to?:
N/A

NCS team lead:
[249]


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