Incident Report

Managing Patient expectations and the first 24 hrs are critical in managing a burn. Notify Dr Kanase Immediately.

Clinic *

Submitter's Name *

Type of Incident *

Patient Name *

Technician (involved) Name *

Procedure Category *

Treatment Type * 🛈

Machine Type *

Settings *

Tx # *

% Improvement *

Event Date * +

Event Time *

Description * 🛈

Patient's Mood *

Patient's Mood - Details * 🛈

Pain Level Immediately Post-Tx * 🛈

Pain Level NOW * 🛈

Icepak applied? *

Yes

Advised to use Hydrocortisone Cream? *

Yes

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