As the health care industry’s most comprehensive library of customizable policy and procedure templates, MCN Healthcare’s Behavioral Health Partial Hospitalization Program Policy and Procedure Manual includes this customizable template, Report of Injuries by Assaultive or Abusive Conduct Form. MCN’s policy library helps you meet compliance with Joint Commission and federal regulations including CMS, CDC, OSHA, OIG, HIPAA and more.

Health care organizations around the world utilize MCN’s compliant ready templates and workflow process tools to help them meet the latest changes in regulations and standards.

Here is some sample content from Report of Injuries by Assaultive or Abusive Conduct Form:

	REPORT OF INJURIES BY ASSAULTIVE OR ABUSIVE CONDUCT Pursuant to Penal Code Section et seq. CONFIDENTIAL Patient's Name: Patient's Whereabouts: Specify where and when patient can be safely contacted. Specify any special instructions for contacting patient: Describe nature and extent of injury: Date of injury, if known: Relationship of suspected perpetrator to patient: Domestic/intimate partner Other; please specify: Name of persons patient alleges inflicted the wound or injury: Was patient informed that he/she may be contacted by law enforcement? Other comments Include any special...
Second excerpt:
	...informed that he/she may be contacted by law enforcement? Other comments Include any special needs of patient, i.e., interpreter Was patient referred to support services? Date: Health Practitioner's Name: Health Practitioner's Title: Health Practitioners Medical Facility: Health Practitioner's Phone Number: Law Enforcement Agency Contacted: Name and Serial Number of Official Contacted: Date/Time of Telephone Report: Return to Local Law Enforcement Agency: Note to Law Enforcement: Reference...