Medication Incident Report PDF Details

Every healthcare facility needs a system for recording medication incidents. A medication incident report form is an efficient way to document and track these events. This form can be used to report any type of adverse drug reaction, from mild to life-threatening. By tracking medication incidents, healthcare facilities can improve patient safety and identify potential problems with specific medications. Themed around how electronic health records could create more comprehensive surveillance of drug reactions leading possibly fewer incidences all together by having EHR pull information related to patients current prescriptions drugs and interactions therein beyond the doctors note as well as diagnosis codes, this post will focus on the not just benefits clinical staff but also hospital administration in reducing risk and incidence rate.

You could find it useful to understand the amount of time you'll need to fill out this medication incident report and exactly how lengthy this

Form NameMedication Incident Report
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namessample incident report medication error, medication error incident report sample letter, in home medication error template, medication error reporting format

Form Preview Example




Date of Birth /


















Child Care Facility
















Time Medication to be administered











Date of Incident

Reason for Report: Missed medication, wrong medication, etc. Give a detailed report as to how incident happened:

Action Taken/Intervention:

Describe how this incident could be avoided in the future:

Name of parent/guardian who was notified:

Time/date of notification:

Printed name of person preparing report

Signature of person preparing report

Follow up contact/care:

Child Care Facility Director/Administrator signature_____________________________________

Watch Medication Incident Report Video Instruction

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