Description

Patient’s self-identified gender

On-Screen Instructions

Please use the patient’s self-identified gender.

Field Type

Responses

• Male

• Female

• Unknown

Guide for Use

Note: If you are reporting an event that impacted multiple patients, please complete a separate form for each patient with their specific demographic data. Other sections of the form may be copied and pasted. If you have questions about this procedure, please contact a patient safety analyst.

History