24-Hour Family Notification of Change in Condition

Documents notification of a resident representative or family member within 24 hours of a resident fall or other change in condition, including who was notified, when, how, and the outcome of the communication.

Resident and Event Overview

• Resident Identifier
  Use the resident's internal ID, room number, or other facility-approved identifier. Do not enter unnecessary PII.
• Event Type
  Select the event that triggered the notification.
• Date of Event
  Select the date the fall or change in condition occurred.
• Time of Event
  Enter the approximate time of the event if known.
• Brief Event Summary
  Provide a concise factual summary of what occurred. Avoid clinical detail beyond what is needed for notification.

Notification Details

• Notification Status
  Indicate whether notification was completed within the required timeframe.
• Date of Notification
  Select the date the notification was made or attempted.
• Time of Notification
  Enter the time the notification was made or attempted.
• Was notification completed within 24 hours of the event?
  Use this field to confirm the 24-hour requirement for the audit trail.
• Method of Notification
  Select all methods used to contact the resident representative or family member.

Person Notified

• Name of Person Notified
  Enter the name of the resident representative, family member, or authorized contact.
• Relationship to Resident
  Select the relationship or authority of the person notified.
• Contact Result
  Record the outcome of the contact attempt.

Follow-Up and Documentation

• Response Summary
  Summarize any questions, concerns, or instructions provided by the person notified.
• Is follow-up required?
  Indicate whether additional communication or action is needed.
• Follow-Up Owner
  Enter the staff member or role responsible for follow-up if needed.
• Supporting Attachment
  Upload any related documentation, such as call notes or communication records.

Reporter Attestation

• Reported By
  Enter the name of the staff member completing this notification record.
• Reporter Role
  Enter the staff role or title.
• Date Reported
  Select the date this form was completed.
• Attestation
  Required acknowledgment for the audit trail.