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