BCEMS TRANSPORT CHART (INTERFACILITY, LZ)

C - Dispatched EC [text name="variable_1" default=""] [select name="variable_2" value="emergency trafic|non- emergency traffic"] to [text name="variable_2" default=""] for an [select name="variable_3" value="interfacility transport|Hospital LZ transport|Doctor Appointment"] from this facility to [text name="variable_3" default=""]. EMS respsonded with [select name="variable_4" value="lights and siren|no light or siren"] using due reguard to life safety.

H - The PT came to [text name="variable_2" default=""] compalining of [textarea name="variable_1" default="Chief complaint"]. After testing and exam, the PT was diagnosed with [textarea name="variable_2" default="Hospital diagnosis"]. The PT is being transferred to [text name="variable_3" default=""] for higher level of care and [select name="variable_1" value="Cardiology|Pulmonolgy|Newborn|Gastrointestinal|Neurology|Orthopedic|Pregnancy|Psych|Rasdiology|Rehab|Dialysis|Trauma|Wound care|Other|"] [text name="variable_5" default=""] which is not available at sending facility. Staff reports the PT [textarea name="variable_3" default="additional info and treatment from staff"]. The PT has a medical history of [checkbox name="variable_1" value="COPD|CHF|HTN|chronic renal failure/CKD|diabetes|cardiac arrhythmias|demenita|parkenson's disease|A-Fib|decubitis ulcers"] [text name="variable_7" default=""]. The PT has allergies to [checkbox name="variable_2" value="PCN|sulfa|amoxicillin|Aspirin"] [text name="variable_8" default=""].  The PT takes various meds which are listed in the ePCR reprot.

A- Upon arrival to [text name="variable_2" default=""] staff gave report and the PT was found in Room [text name="variable_11" default=""].  The PT is found to be alert and Oriented X [text name="variable_13" default=""] with a GCS of [text name="variable_6" default=""]. The PT skin is [checkbox name="variable21" value="warm, dry and normal color|warm|cool|cold|pale|dry|cyanotic|mottled|jaundiced"]. 

The PT has [checkbox name="variable22" value="bilateral radial pulses present|pedal pulses present |absent radial pulses|absent pedal pulses|unilateral radial pulse present |unilateral pedal pulse present|bilateral brachial pulses presnet|unilateral brachial pulse present"]. 
HEENT was noted as [checkbox name="variable23" value="unremarkable|abnormal"] [text name="variable_8" default=""]. 
The PT puipls are [checkbox name="variable24" value="equal|unequal"], left pupil is [text name="variable_10" default=" xxMM"] right pupil is [text name="variable_12" default=" xxMM"]. The PT lungs are [checkbox name="variable25" value="equal and clear bi lateral|left diminished|right diminished|left absent|right absent| left wheezing|right wheezing"]