意外事件调查表

发布时间:2015-08-02 来源:

床号:            姓名:         性别:     年龄:      入住日期:      

事件发生日期:                         时间:        


住户关于事件的描述:       






                                                    
                                                                               
                                                                                  
                                                                              
                                                                               
工作人员关于事件的描述(包括时间发生的环境情况,住户的体位,受伤部位及伤口的大小,处理过程等):



                                                                              
                                                                                  
                                                                                  
                                                                                  
                                                                                
                                                                              
                                                                                
参加讨论人员:
                                                                                  
                                                                                 
事件讨论意见:
                                                                                 
                                                                               
                                                                              
                                                                               
                                                                                
                                                                              
                                                                               
护理员签字:                           护士签字:                 
护理长签字:                           护理主任签字:      





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