SkinPen (Crown Aesthetics Reportable incidents)

SkinPen (Crown Aesthetics Reportable incidents)

SECTION 1. CONTACT INFORMATION

Name
Name
First Name
Last Name

SECTION 2. INCIDENT DETAILS

Maximum file size: 516MB

Check if section 3 is not applicable for you
If complaint is not related to an Adverse Patient Event the following section will be marked "Not Applicable" and only section 1 and 3 require completion

SECTION 3. ADVERSE EVENT TRIAGE QUESTIONS

Was Medical Intervention Required?
What Was The Purpose of The Treatment?
Is There Another Appointment With The Patient Scheduled?
Are There Pre and/ or Post Treatment Pictures Available
Has There Been Any Resolution Since Incident/ Report?
Did The Customer Request Additional Follow-up After Incident?

SECTION 4. RESOLUTION