H-38 Medical Event Reporting Form
Diagnostic Imaging
Welcome to the Medical Event reporting form for Diagnostic X-ray Imaging
We ask that you use the following naming convention for the “Medical Event Name” field:
- The 2 letter abbreviation for your state.
- Dash (-)
- The date of the incident in month-day-year.
- X (diagnostic XRAY imaging)
- Dash(-)
- Abbreviation of facility
An example would look like:
CA-1-10-2025X-Mem (California, January 10, 2025, Therapy Event at Memorial Hospital)
This naming convention will allow us to keep submissions organized in the database.
Complete the form below and click “Submit”.
If you have any questions about the online event submission process, please contact Bruce Hirschler at bhirschler@crcpd.org