Free Medical Office Incident Report

I. Incident Details
A. Date and Time of Incident:
May 15, 2050, 10:30 AM
B. Location of Incident:
Reception Area
C. Incident Description:
A patient became agitated while waiting for their appointment and started yelling at the receptionist, demanding to be seen immediately
II. Persons Involved
A. Patient Information:
Information | Details |
|---|---|
Name: | John Smith |
Date of Birth: | January 10, 1985 |
Address: | 4743 Hill Street, Florida, OH 43545 |
Contact Number: | 555-123-4567 |
B. Staff Member Involved:
Information | Details |
|---|---|
Name: | Emily Johnson |
Position: | Receptionist |
Department: | Front Desk |
Contact Information: | emily.j@email.com |
III. Witnesses
A. Witness 1:
Information | Details |
|---|---|
Name: | Sarah Smith |
Contact Information: | sarah.smith@email.com |
B. Witness 2:
Information | Details |
|---|---|
Name: | David Brown |
Contact Information: | david.brown@email.com |
IV. Incident Assessment
A. Severity of Incident:
Medium
B. Impact on Operations:
The incident caused disruption to the waiting area and created tension among other patients.
C. Immediate Action Taken:
The receptionist calmly attempted to de-escalate the situation and offered the patient a private space to discuss their concerns.
V. Recommendations
A. Preventive Measures:
Implement training sessions for staff on handling difficult situations and de-escalation techniques.
Consider installing panic buttons in the reception area for immediate assistance in similar situations.
B. Training Needs:
Provide additional training for all front desk staff on conflict resolution and customer service skills.
VI. Follow-Up Actions
A. Follow-Up Date:
May 20, 2050
B. Follow-Up Responsible:
Emily Johnson
C. Status Update:
Emily Johnson has completed the training module on conflict resolution and has reported feeling more confident in handling similar situations in the future.
VII. Attachments
CCTV footage of the incident
Incident log entry
For any further inquiries or updates regarding this incident report, please contact [Your Name] at [Your Email] or [Your Company Name] at [Your Company Email].
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Document medical office incidents efficiently with Template.net's Medical Office Incident Report Template. This editable and customizable resource offers a structured format for detailing incidents in healthcare settings. Seamlessly tailor and refine your report using our Ai Editor Tool, ensuring accuracy and compliance with regulations. Enhance incident management processes, exclusively on Template.net.
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