Type 2 Occurrence Report

Type 2 occurrences are to be reported to the College annually by the designated Registrant. Type 2 occurrences as defined in the General Regulation are:

  • Any infection occurring in a patient in the premises after a procedure was performed at the premises.
  • An unscheduled treatment of a patient by a Registrant occurring within five days after a procedure was performed at the premises.
  • Any adverse drug reaction occurring in a patient after a procedure was performed at the premises.


An adverse drug reaction is defined as a harmful and unintended response by a patient to a drug or substance or combination of drugs or substances that occurs at doses normally used or tested in humans for the diagnosis, treatment or prevention of a disease or the modifications of organic function.

 

PART 1: PREMISES INFORMATION

Please provide the following information about the premises (clinic) where the occurrence happened.

 

Please enter the name of the clinic (the registered IVIT Premises) at which the occurrence happened.

 

Please enter the number and street name where the clinic (the registered IVIT Premises) is located.

 

Please enter the City in which the clinic (the registered IVIT Premises) is located.

 
 

Please enter the Postal Code of the clinic (the registered IVIT Premises).

 

To provide context to the overall number of Type 2 occurrences, please indicate the number of IV bags that were compounded on site for the purpose of intravenous infusion therapy between March 2, 2024 and March 1, 2025 (if compounding is not done on site, please enter “0”).

 

To provide context to the overall number of Type 2 occurrences, please indicate the number of instances where intravenous infusion therapy was administered to patients in this premises between March 2, 2024 and March 1, 2025.

 

 

 

PART 2: DESIGNATED REGISTRANT INFORMATION

 

Please enter your first name.

 

Please enter your last (family) name.

 

Please enter your College Registration number.

 

Please enter your e-mail address.

 

 

 

PART 3: OCCURRENCE INFORMATION

The following sections will ask for specific information about occurrences in three areas:

A. Infections

B. Unscheduled Treatments

C. Adverse Drug Reactions.


This form is a dynamic form and it will adjust the questions based on your responses in certain areas.

 

A. Infections

 

During the period of March 2, 2024 to March 1, 2025, were there any instances of an infection that occurred in a patient after receiving IVIT at this premises?

 

 

B - Unscheduled Treatments

 

During the period of March 2, 2024 to March 1, 2025, were there any instances where an unscheduled treatment of a patient by a Registrant occurred within five days after a procedure was performed at this premises.

 

 

C - Adverse Drug Reactions

 

During the period of March 2, 2024 to March 1, 2025, where there any instances of an adverse drug reaction in a patient after a procedure was performed at this Premises?

 

 

 

PART 4 - DECLARATION AND SIGNATURE

 


Do you declare that to the best of your knowledge, the information is true and complete and that you understand that it may be professional misconduct to make a false or misleading statement to the College?

 

Signature


By checking the box below, you are affixing a signature to this form and indicating that this form and the information contained herein is bound directly to you.

 

 

 

PART 5 - Submission Copy

Below is a check box to allow you to receive a copy of your submission. It is strongly recommended that you check this box off and enter your email address. The entries you have made on the form will be emailed to you for your records. This will be helpful in the event that the Inspections Team needs to contact you to clarify any information that you have provided.

 

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