BHFR DIALYSIS TRANSFER NARRATIVE

DISPATCH: [textarea name="dispatch" default=" "]

ARRIVED: [textarea name="arrived" default=" "]

MEDICAL TRANSPORT FOR FOLLOWING REASON: [checkbox name="TRANSFER" value="HEMODIALYSIS"][text name="TRANSFER" default=" "]

PATIENT BEDBOUND PER MEDICARE DEFINITION (MUST MEET ALL 3 REQUIREMENTS): [checkbox name="BEDBOUND" value="YES|NO|CANNOT TRANSFER FROM BED WITHOUT ASSISTANCE|NON-AMBULATORY WITHOUT ASSISTANCE|CANNOT SIT ERECT UNASSISTED IN CHAIR OR WHEELCHAIR FOR A DURATION/ANY PART OF TRIP"]

PATIENT REQUIRED: [checkbox name="CARE" value="OXYGEN ENROUTE|SPECIAL ORTHOPEDIC HANDLING (BACKBOARD, HALO TRACTION, NON WEIGHT BEARING, PINS AND TRACTION)|SPECIAL POSITIONING FOR|DECUBITUS ON BUTTOCKS|CONTRACTURES|RECENT EXTREMITY FRACTURE|POST SURGERY|MAXIMUM ASSISTANCE DUE TO MORBID OBESITY"][text name="ros_heme" default=" "]

CC: [text name="CC" default=" "]

Hx:
Onset (NUMBER OF YEARS OR WEEKS ON DIALYSIS): [text name="O" size = 55 default=" "]
Other PERTINENT Hx (WHY THEY REQUIRE STRETCHER TRANSPORT): [textarea name="hpi" default=" "]

PMHx: [textarea name="pmhx" default=" "]

ALLERGIES: [checkbox name="allergies_check" value="NKDA"][textarea name="allergies" default=" "]

INITIAL ABC's:
-AIRWAY: [checkbox name="airway" value="NORMAL AIRWAY OPEN, PATENT, AND WITHOUT OBSTRUCTIONS|ON NASAL CANNULA WITH OXYGEN BETWEEN 2-6 LITERS PER MINUTE"][text name="airway" default=" "]

-BREATHING: [checkbox name="breathing" value="NORMAL BREATHING WITH ADEQUATE RATE AND TIDAL VOLUME"][text name="breathing" default=" "]

-CIRCULATION: [checkbox name="circulation" value="NORMAL, PULSES INTACT, SKIN COLOR AND TEMPERATURE APPROPRIATE|WITHOUT PRESENCE OF OBVIOUS LIFE THREATS TO CIRCULATION|HEMORRHAGE PRESENT BUT CONTROLLED BY PRIOR INTERVENTIONS|DIALYSIS GRAFT OR FISTULA IN LEFT ARM|DIALYSIS GRAFT OR FISTULA IN RIGHT ARM|TEMPORARY DIALYSIS GRAFT IN CHEST"][text name="ros_constitutional" default=" "]

LEVEL OF CONSCIOUSNESS: [checkbox name="loc" value="ALERT|ORIENTED|PERSON|PLACE|TIME |EVENT|DISORIENTED"][text name="consciousness" size = 55 default=" "]

TREATMENT: [checkbox name="treatment" value="PRIMARY AND SECONDARY BLS ASSESSMENT|CONTINUATION OF OXYGEN THERAPY DURING TRANSPORT"] [textarea name="rxt" default=" "]

TRANSPORT: [checkbox name="pe_trans_check" value="SECURED PATIENT TO STRETCHER WITH 3 STRAPS AND RAILS UPRIGHT|LOADED INTO AMBULANCE FOR TRANSPORT|NON EMERGENCY|TRANSPORTED TO DAVITA DIALYSIS|TRANSPORTED TO BARBOUR COUNTY DAVITA DIALYSIS|TRANSPORTED TO DCI|TRANSPORTED TO RESIDENCE"][text name="pe_trans" default=" "]

REPORT: [checkbox name="pe_rep_check" value="VERBAL REPORT TO NURSE|PATIENT BELONGINGS LEFT WITH NURSE|NO CHANGE IN PATIENT CONDITION"][text name="pe_rep" default=" "]

REPORT WRITER: [checkbox name="pe_RW_check" value="MNL PARAMEDIC 0500209|PES PARAMEDIC 1800088|CD PARAMEDIC 1500386|JJO PARAMEDIC 1800129|AP AEMT 1600382|JMP AEMT 1700742|BDG EMT 1900684|GEL EMT 1700263|CMW EMT 2000760"][text name="RW" default=" "]