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submit new
AOR
Adverse Occurrence Report
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[#]. This is a question with free form input(s)
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Florence Johnson
Florence Johnson
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FL
-BOC
FL
-BOC Palms
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orence Johnson
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orence Johnson
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[#]. This is a question with autocomplete
FL-BOC Palms
FL-BOC Palms
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FL
-BOC
FL
-BOC Palms
Fl
orence Johnson
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[#]. This is a question with date selector
mm/dd/yyyy
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Report a patient or facility adverse occurrence:
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15% Complete
1. When did the event occur?
mm/dd/yyyy
2. In what facility did the event occur?
Select Facility
First Choice
Second Choice
Third Choice
3. Did this incident involve a patient?
Yes
No
4. Enter patient name:
FL-BOC Palms
Enter clinic name
FL
-BOC
FL
-BOC Palms
Fl
orence Johnson
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5. Was this a bloodwork issue?
Yes
No
6. Type of bloodwork issue:
Blood not drawn
Blood not transported
Bloodwork not in EMR
7. Reason:
Blood tubes not available
Ran out of shipping boxes
Ran out of cold packs
Unable to print labels
Package was not shipped
Other
[#]. Was this a missed treatment?
Yes
No
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