Click here for the Severity Assesment Code (SAC) it will open in a new browser window so you can keep filling out your RCA
Post the incident a risk evaluation should occur go to the site of the incident or talk directly to the people involved and evaluate the risk of this incident reoccurring. As part of this evaluation place controls immediacy to prevent reoccurrence. Notify senior Medical and management staff immediately. Ensure a full disclosure has occurred to the patient and or family.
NOTE! if you do not have a recommendation or action to add at this point in time, please click NEXT button at the bottom of the form.
NOTE! You can come back at a later date and add reccomenations and actions.
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Thank you for taking the time to fill out your RCA Application. Please Note all infomation will be submitted to a secure data base.
NOTE! An email will be sent to your Email address provided in this RCA application.This is where you can ADD or RE-EDIT your RCA application.