MIRF REPORT
Request:
Medical – fell on playground
Campus:
Vista
Location/Building:
[68]
Date of Incident:
February 6, 2022
Time of Incident:
11:10 AM
Number of Patients for this Incident:
[75]
List Patient(s) Name, Age, Parent/Guardian (if under 18),… :
Mayzie Storno – 2 yrs
Luke Storno and Kim Palazzo – (414) 688-8083
Describe Medical Event:
Fell on playground outside 2 yr old preschool room
Actions Taken by Team Members:
[79]
Number of NCSM Team Members Involved:
[81]
List Name(s) of NCSM Team Members Involved:
Bryan Hall, Ashley Valentin, Scott, Gary Horn
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?:
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