MIRF REPORT
Request:
Medical – fall, bumped head
Campus:
Vista
Location/Building:
[68]
Date of Incident:
August 14, 2022
Time of Incident:
10:15 AM
Number of Patients for this Incident:
[75]
List Patient(s) Name, Age, Parent/Guardian (if under 18),… :
Charlotte Kozik, 14 mos, Amanda and Paul Kozik, 7605054941, 7605006696
Describe Medical Event:
Pt tripped over leg of Volunteer, fell, and hit her forehead on the floor. There was an inch and a half long red bruise on R side of forehead underneath her hairline.
Actions Taken by Team Members:
[79]
Number of NCSM Team Members Involved:
[81]
List Name(s) of NCSM Team Members Involved:
Brent and Kia Ruth
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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