[Verified Answer]: Complete the incident report form provided…

Complete the incident report form provided for the following situation, using yourself as the person responsible for the incident. Please note the form does have some pull down options. On 1 May, 20XX, you received a properly filled out release of information form for a patient by the name of Martha Stewart. Ms. Stewart is a patient of Dr. Sirgourney Weaver, and is moving to a new state, and wants all her electronic medical records from the past 10 years faxed to her new provider, Dr. Mary Jones, 123 Anyway Practice, 120 S. 14th Street, Littleton, CO 80123, using the fax number 877-123-1234. The Anyway practice’s phone line is 800-222-1111. You do not call Dr. Mary Jone’s office to verify the fax number, but you do use a fax cover sheet with a confidentiality statement on it, with return information. In the process of faxing Ms. Stewart’s medical records, you enter the wrong fax number, however, you do not realize this until the next day. On 2 May, 20XX, at 1000, the Bank of America’s Loan department calls your office to tell you they received Ms. Stewarts medical records, and would like to know what to do with them. You ask the person from the loan department their name, how many pages they received, who had access to the fax machine that the fax was received at, when it was received, and if they have a shredder in which they could destroy the documents (they do, and will destroy the documents, and send you confirmation of this). Be sure to provide as much detail as possible, using the events from the scenario. You may insert names (ex. loan officer, etc) and times as needed. In the comments sections, be sure to use proper spelling and grammar; and again, provide as much information as possible (but be clear and concise), with regards as to future prevention, and actions taken to notify affected parties, if any.