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Automatically assigned

n/a (automatically assigned by PSRP online system)

Check all that apply

Select all that apply.

Checkbox

Checkbox (multiselect)

Dropdown

Dropdown (single select)

Harm algorithm link

PSRP Harm Categories and Algorithm (pdf)

Made required when triggered

Made required when triggered.

Multiple patients

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 OPSC staff.

No additional guidance

No additional information provided.

Other selection text

If “Other” is selected, a text box for a description will also appear.

Radio Button

Radio button (single select)

Select only one

Select one.

Serious event

This event type is always considered a reportable event, regardless of level of patient harm.

Staff contact info

You can include up to five

One instance of this question is required to submit a report, but you may include up to five.