This form is used to capture incident, clinical and personal information about patients presenting during our events.
Please note some incidents may be reportable under Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) HSE Requirements (More Info).
Once a report has been submitted, it cannot be edited or amended further.
Please enter as much detail as possible, please be careful to select the options that best describe your patient.