Event report Form/Variance report Variance Report Date of Event(Required) MM slash DD slash YYYY MRN or RX Number:Patient / Employee / Visitor Name:(Required)Department(Required)Physician Notified?(Required) Yes No Physician Name:(Required)Select a Manager to be Notified(Required)braunschweig.joshua@bvrmc.orgisadmin@bvrmc.orgInformationSystems@bvrmc.orgAdditional Manager 1hull.jacob@bvrmc.orgbraunschweig.joshua@bvrmc.orgInformationSystems@bvrmc.orgAdditional Manager 2hull.jacob@bvrmc.orgbraunschweig.joshua@bvrmc.orgInformationSystems@bvrmc.orgNarrative: (Please Include the Time of Event)
