A 13-page safety and security report released Wednesday examines events leading up to the December killing of 51-year-old social worker Alberto Rangel and details steps taken since the attack.
Rangel was stabbed in the neck while working at the hospital's outpatient HIV clinic and died two days later.
RELATED: Social worker dies after stabbed by patient at SF General Hospital; suspect arrested: authorities
The suspect, 34-year-old Wilfredo Jose Tortolero Arriechi, is facing a murder charge.
According to the San Francisco Department of Public Health assessment, Arriechi had visited the clinic at least three times in the three weeks before the stabbing.
During his first visit on Nov. 13, Arriechi went to the clinic looking for his physician, who was not there. He was escorted out of the building, the report states.
One week later, on Nov. 20, Arriechi met with his physician and threatened to sue him. The assessment says his "elevated" behavior was reported to security.
On the morning of Dec. 4, Arriechi again attempted to see his physician, who was not present. Staff reported that Arriechi said he would return that afternoon at 1 p.m., and security and a sheriff's department lieutenant were notified.
Arriechi returned around 1:30 p.m. and was meeting with Rangel in what was described as a calm conversation. Witnesses told investigators that Arriechi then stabbed Rangel.
RELATED: Social worker in critical condition after being stabbed by patient at SF General Hospital: sheriff
Since the attack, hospital officials have added new security measures at the building where the stabbing occurred. The changes include increased security staffing and the installation of a weapons detection system, including metal detectors.
Union leaders representing hospital workers say the improvements are a step forward but argue broader staffing issues remain unresolved.
"We have been grateful that they have been able to make some physical changes," said Matias Campos, executive vice president of UPTE, the union representing more than 15,000 University of California workers, many of whom work at San Francisco General Hospital.
Campos said high patient-to-staff ratios continue to pose safety concerns.
"Our social workers based there actually had very high patient ratios on the order of 600 to 700 patients per social worker," Campos said. "But what we want to know and what we need the city and county to push UCSF on, as our employer, is to really make commitments to increase staffing."
UCSF officials had not responded to a request for comment following the release of the report.
The full safety and security assessment is available online.