Documentation of Insufficient Staffing/Unsatisfactory Patient Care [Community Setting]
I believe the situation as described below is inadequate to provide safe patient care and does not meet accepted standards of care. While I will continue to provide the best professional care possible in this situation, I decline to accept responsibility for any untoward events that may occur as a result of insufficient staffing by the agency/facility.
Download community setting reporting form as a PDF, or use the interactive form below:
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