Which fields on the form must be filled out in order to submit a nursing facility report?
The form contains required questions that must be completed in order to submit any report. Depending on the event type selected, there may be additional event-specific questions that must be completed prior to submission. If needed, you will be able to save a partially completed form regardless of whether the required fields are completed.
The following questions are required for any adverse event report:
General Information
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Select your facility (Nursing Facility) (PSRP Knowledge Base)
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Contact phone (PSRP Knowledge Base)
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Contact email address (PSRP Knowledge Base)
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Contact name (PSRP Knowledge Base)
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Date discovered (PSRP Knowledge Base)
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Patient ethnicity (PSRP Knowledge Base)
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Patient race (PSRP Knowledge Base)
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Patient age (PSRP Knowledge Base)
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Event date (PSRP Knowledge Base)