MIRF REPORT
Request:
Fall
Campus:
San Marcos/Escondido
Location/Building:
[68]
Date of Incident:
October 19, 2025
Time of Incident:
11:30 AM
Number of Patients for this Incident:
[75]
List Patient(s) Name, Age, Parent/Guardian (if under 18),… :
Hazel Belle Bultemeier
2 y/o
Parent: Joshua Bultemeier
760-576-9506
Describe Medical Event:
Staff member states that patient was walking across the room when she tripped and fell and landed on her head in the prone position. Staff member states that patient picked herself up off the floor and was not crying or showing any signs of distress.
Upon examination of the patient, Patient is alert and oriented and acting appropriate for her age. Patient is showing no obvious signs of distress. Patient has an approximately half inch by half inch red spot to her right eyebrow proximal to the patient’s nose. Patient denies pain to the affected area. No swelling noted.
Patient left in the care of staff members and parents were notified of the incident.
Actions Taken by Team Members:
[79]
Number of NCSM Team Members Involved:
[81]
List Name(s) of NCSM Team Members Involved:
Via
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]
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