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System variance reporting

Report a system variance

Name
Threat to Public Safety
Negative Patient Outcome due to Medication Error or Policy Violation
Public Concern
Potential Clinical Care Variance
Potential Policy Variance
Interagency Coordination
General Complaint
Communications System Variance
Other: Please describe in Narrative
Good Patient Outcome
Outstanding Service
Excellence in the Line of Duty
Other: please describe in narrative
Include specific and detailed information about the incident, location, times, persons involved, witnesses, actions taken, notifications given, and anything else relevant.