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ODIS Directive #[removed] Attachment B CRITICAL INCIDENT REPORT FORM (CIR) Send typed CIR to [removed]_ Incident # Date of Report
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Document Date: 2012-02-16 08:37:50

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File Size: 338,50 KB

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IndustryTerm

law enforcement services / /

MedicalCondition

Choking Chronic Liver Disease Chronic Lower Respiratory Disease Diabetes Diseases / Accidents Bowel Obstruction Cancer Cerebrovascular disease / injury requiring minor first aid Staff injury / injury / stroke / /

MedicalTreatment

first aid / Medication errors / /

Organization

State Hospital / /

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Position

death Medication Dose Route Frequency Administrator / first aide / contractor / Regulatory Services Support Coordinator/Broker / /

Product

Heart Hypertension Medication / /

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