| Time, location and site of incident | Date, country and site of incident (practice, nursing home, emergency service, house call, other) |
| Patient affected? | Yes, no |
| Patient | Age, gender, familiarity with the patient, disabilities, non-German speaking |
| Medication | Phase of the medication process, type of medication incident, other important conditions, trade and generic name, application form, dose |
| The incident (narrative section) | What happened? What was the outcome? What were possible causes? Strategies to prevent incident recurring |
| Contributing factors | One main factor and two secondary factors contributing to the incident (out of 10 different factors) |
| Other providers involved? | Other GPs, physiotherapist, hospital, other specialist practitioners |
| Frequency | First time, annually, monthly, weekly, daily |
| Severity of outcome | Harm categorised according to the NCC MERP Medication Error Taxonomy (see box 3) |
| Type of practice | Rural/urban, single/group practice, size (number of patients attended per quarter) |