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Step 1: Press the "Get Form" button above on this webpage to open our editor.
Step 2: After you open the file editor, there'll be the form made ready to be completed. In addition to filling out different fields, it's also possible to perform some other actions with the Document, namely writing your own words, changing the initial text, adding images, signing the document, and a lot more.
When it comes to blanks of this particular PDF, here's what you should consider:
1. The dhh louisiana critical incident report form will require specific details to be inserted. Ensure the following fields are complete:
2. The next step is usually to submit these fields: EDA ADHC ARC CC, Marital Status Race, Living Situation, Single Married Divorced Separated, African American White Hispanic, With Relatives With OtherUnknown, Competent Major Interdicted, Disability Person having, Institutional Transition, Yes, Autism BrainHead Injury Cerebral, Mental Illness MR Mild MR Moderate, Speech Dysfunction Quadriplegia, Type, and Nursing Facility SSC DC ICFDD.
3. The following part should be quite simple, Participant Name, SSN, INCIDENT CATEGORIES Check only, Note All protective services, Note to Support Coordinator SC If, Elderly Age or older, Abuse Neglect Exploitation, Abuse Neglect Exploitation, Major Injury, Fall, Death, and Loss or Destruction of Home - each one of these form fields is required to be filled in here.
4. This next section requires some additional information. Ensure you complete all the necessary fields - Major Injury, Fall, Death, Loss or Destruction of Home, Major Illness, Major Behavioral Incident, Major Medication Incident, Pharmacy Error Staff Error Family, Attempted Suicide Suicidal Threats, Behavior, Sexual Aggression Physical, Involvement with Law Enforcement, Participant arrested Staff, Moving Violation, and Participant is a victim - to proceed further in your process!
Regarding Fall and Participant arrested Staff, be certain that you take a second look in this section. Those two are considered the key ones in this file.
5. Since you come close to the completion of this file, you'll find several extra points to undertake. Notably, Participant Name, SSN, EVENT INFORMATION, Incident Occurred DateTime AM or, Location of incident, Home Community Facility Vehicle, DSP notified EPS DateTime AM or PM, Type of Health Care Admissions and, Psychiatric Hospital, Date Date Date Date, Acute Care Hospital Respite Center, Date Date Date Date, Reporter Name Relationship, APS Child Child Protection Curator, and EPS FriendNeighbor Guardian Home should be done.
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