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e-IR 2.0 | Incident Reporting & Learning System (SABAH) | DELETING AN ENTRY
REPORTING FORM FOR MINISTRY OF HEALTH HOSPITALS / INSTITUTIONS ONLY
Fill in this form to delete report that had been submitted to us due to wrong entry.
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* Indicates required question
Email
*
Your email
Date of submitting the wrong entry
*
Your answer
Hospital Code
*
Refer to the code provided.
Your answer
Type of Incident
*
Choose
Wrong surgery/procedure –wrong site, side or patient
Unintended retained foreign body in patient after an operation/procedure
Error in transfusion of blood/blood products
Medication error (please fill in MERS form as well)
Patient fall in the facility
Obstetric related incidents
Adverse outcome of clinical procedure
Pre-hospital care and ambulance service related incident
Radiotherapy related incident
Patient suicide / attempted suicide
Patient discharged to wrong family members / next-of -kin
Assault/ battery of patient
Unanticipated Fire – Fire, flame, or unanticipated smoke, heat, or flashes occurring in the facility
Others
If you select 'Others', please describe the incident
Your answer
Name of reporting officer
*
Your answer
Designation reporting officer
*
Your answer
Phone Number
*
Your answer
Reference Number
*
Fill in the reference number used in the previous error report entry.
Your answer
Please re-submit the corrected incident report after completing this form.
Send me a copy of my responses.
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