CERT PCR
Incident:[textarea name="incident" default=" EMT responded to medical call for "] Upon Arrival: [textarea name="ptinfo" default=" On arrival EMT "] Complaints: [textarea name="Chiefcomplaint" default=" "] Onset: [text name="O" size = 55 default=" "] Additional Signs/Symptoms Reported: [textarea name="s" size = 55 default=" "] Allergies: [text name="a" size = 55 default="NKDA"] Medications: [text name="m" size = 55 default=""] Past Med Hx: [text name="p" size = 55 default=""] History of present illness: [textarea name="e" size = 55 default=" "] Other Hx Info: [textarea name="hpi" default=" "] Assessment: General/Overall Appearance: [textarea name="appearance" default=" The patient appears well nourished, well developed, and appears/does not appear to be in acute distress. "] Airway: [checkbox name="airway" value="open, maintained by patient, with no concern for compromise |open. |maintained by patient. |no concerns for compromise. |not open. |compromised. |requires manual opening. |requires airway adjunct. |requires advanced airway."][text name="airway" size = 55 default=" "] Breathing: [checkbox name="breathing" value="breathing spontaneously, non-labored, with a regular rate and adequate tidal volume. |tachypneic. |deep. |bradypneic. |shallow. |agonal. |apneic. "][text name="airway" size = 55 default=" "] Circulation: [checkbox name="circulation" value="normal and without concerns. |regular and normal pulse rate. |tachycardic. |bradycardic. |weak pulse. |massive hemorrhage. |diminished perfusion. | pulseless. "][text name="airway" size = 55 default=" "] Level of Consciousness: [checkbox name="loc" value="alert and oriented to person, place, time, and event. |alert. |oriented. |disoriented. |person. |place. |time. |event. |arousable by verbal stimuli. |arousable by painful stimuli. |unresponsive."][text name="consciousness" size = 55 default=" "] SKIN: [checkbox name="skin" value="pink, warm, and dry. |pale, cool, and clammy. |pink. |warm. |dry. |pale. |cool. |clammy. |diaphoretic. |hot. |flushed. |cyanotic. |lividity. |Jaundiced. "][text name="skin" size = 55 default=" "] HEENT: [checkbox name="head" value="normal and atraumatic. |no reported pain. |nupils equally round and reactive."] Neck: [checkbox name="neck" value="normal and atraumatic. |JVD. |no JVD. |tracheal deviation. |no tracheal deviation. |no reported pain."][text name="neck" size = 55 default=" "] Chest: [checkbox name="chest" value="normal and atraumatic. |breath sounds clear equal bilaterally. |no reported pain."][text name="chest" size = 55 default=" "] Back: [checkbox name="back" value="normal and atraumatic. |no reported pain."][text name="back" size = 55 default=" "] Abdomen: [checkbox name="abdomen" value="soft, non-tender, and atraumatic. |no pain. "][text name="abdomen" size = 55 default=" "] Pelvis: [checkbox name="pelvis" value="normal and atraumatic. |no reported pain. "][text name="pelvis" size = 55 default=" ] Extremities: [checkbox name="extremities" value="normal and atraumatic. |equal strength x4. |unequal strength. |cap refill less than 2 seconds. |no reported pain. "][text name="extremities" size = 55 default=" "] Additional Assessment Findings: [textarea name="additassess" default=" "] Vital Signs: HR: [text name="0" default="BPM"] RR: [text name="0" default="BPM"] BP: [text name="0" default="mmHg"] BGL: [text name="0" default="mg/dl"] SPO2:[text name="0" default="%"] Rx: Treatment included: [checkbox name="treatment" value="primary and secondary BLS assessment. |airway adjunct placed. |oxygen administered. |AED used. |CPR performed. |first aid/wound care. |Assisted ventilations with BVM.|suction used. |cervical collar placed.|topical wound care applied"] [textarea name="rxt" default=" "] TRANSPORT: [checkbox name="pe_trans_check" value="Pt transported by EMS. |WorkCare recommended pt go to uregent care. |Pt returned to work. |Not transported. "][textarea name="pe_trans" default=" "] Destination: [checkbox name="dest" value="Urgent Care. |Returned to work. |Transported by EMS. |ER."] [textarea name="destcheck" default=""] Narrative: [textarea name="variable_1" default=""] Provider: [text name="prov" size = 45 default=" "] [checkbox name="care" value="EMT."]
Result - Copy and paste this output:
Sandbox Metrics: Structured Data Index 0.33, 49 form elements, 56 boilerplate words, 21 text boxes, 12 text areas, 16 checkboxes, 124 total clicks
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