Complete Note
Loading Add to Favorites
Share
Tweet
Cite
Incident/Dispatch:[textarea name="incident" default=" "]

Complaints: [textarea name="Chiefcomplaint" default=" "]

Hx:
Onset: [text name="O" size = 55 default=" "]
Provoking/Relieving Factors: [text name="P" size = 55 default=" "]
Quality/Described As: [text name="q" size = 55 default=" "]
Radiation: [text name="r" size = 55 default=" "]
Severity: [text name="s" size = 55 default=" "]
Acute/Chronic: [text name="t" size = 55 default=" "]
Additional Signs/Symptoms Reported: [textarea name="s" size = 55 default=" "]
Allergies: [text name="a" size = 55 default=" "]
Medications: [text name="m" size = 55 default=" "]
Past Med Hx: [text name="p" size = 55 default=" "]
Events Surrounding Condition: [textarea name="e" size = 55 default=" "]
Other Hx Info: [textarea name="otherhx" default=" "]

Assessment:
General/Overall Appearance: [textarea name="appearance" default=" "]
SKIN: [checkbox name="skin" value="pink.|warm.|dry.|pale.|cool.|clammy.|hot.|flushed.|cyanotic.|lividity.|jaundiced."][text name="skin" size = 55 default=" "]
HEENT: [checkbox name="head" value="normal and atraumatic.|pupils equally round and reactive."][text name="head" size = 55 default=" "]
Neck: [checkbox name="neck" value="normal and atraumatic.|no JVD.|No tracheal deviation."][text name="neck" size = 55 default=" "]
Chest: [checkbox name="chest" value="normal and atraumatic.|breath sounds clear equal bilaterally."][text name="chest" size = 55 default=" "]
Back: [checkbox name="back" value="normal and atraumatic."][text name="back" size = 55 default=" "]
Abdomen: [checkbox name="abdomen" value="normal and atraumatic.|no pain."][text name="abdomen" size = 55 default=" "]
Pelvis: [checkbox name="pelvis" value="normal and atraumatic."][text name="pelvis" size = 55 default=" ]
Extremities: [checkbox name="extremities" value="normal and atraumatic.|equal grip strength x4.|cap refill less than 2 seconds.|skin pink warm dry."][text name="extremities" size = 55 default=" "]
Additional Assessment Findings: [textarea name="additassess" default=" "]
EKG: [checkbox name="ekg" value="12 lead EKG.|4 lead cardiac monitoring.|normal sinus rhythm.|sinus tachycardia.|no ST Elevation or ectopy.|no EKG performed."][text name="ekg" size = 55 default=" "]
Vital Signs: [textarea name="vitals" default=" "]
Impression: [text name="imp" size = 55 default=" "]

Rx:
Treatment included: [checkbox name="treatment" value="primary and secondary ALS assessment.|cardiac monitoring enroute. "] [textarea name="rxt" default=" "]



TRANSPORT/Changes during Transport: [checkbox name="pe_trans_check" value="Secured to stretcher. |loaded for transport.|Emergency.|Non Emergency.|Emergency Downgraded to Non Emergency. |Non Emergency Upgraded to Emergency.
|refusal.|AMA.|treat and release.|no transport. |lift assist only.|transported to closest ER. |Transported to Trauma Center. |Handoff given to nurse at bedside. |No changes noted. "][textarea name="pe_trans" default=" "]
Incident/Dispatch:

Complaints:

Hx:
Onset:
Provoking/Relieving Factors:
Quality/Described As:
Radiation:
Severity:
Acute/Chronic:
Additional Signs/Symptoms Reported:
Allergies:
Medications:
Past Med Hx:
Events Surrounding Condition:
Other Hx Info:

Assessment:
General/Overall Appearance:
SKIN:
HEENT:
Neck:
Chest:
Back:
Abdomen:
Pelvis:
Extremities:
Additional Assessment Findings:
EKG:
Vital Signs:
Impression:

Rx:
Treatment included:



TRANSPORT/Changes during Transport:
Result - Copy and paste this output: