H-38 Medical Event Reporting Form
Therapy
Welcome to the Medical Event reporting form for Therapy.
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.
- Th (Therapy)
- Dash(-)
- Abbreviation of facility
An example would look like:
CA-1-10-2025Th-Mem (California, January 10, 2012, 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