DH IFT

Dispatch: On    [date name="variable_1" default=""] while on shift, crew was dispatched for        IFT    from    [text name="variable_1" default="sample text"]    to    [text name="variable_2" default="sample text"].Crew responded without delay.  There were no incidents while responding.

Scene:
[textarea name="variable_3" default="sample text"]

Complaints: 
Upon arrival at scene, crew located the patient [textarea name="Chiefcomplaint" default=" "].  [text name="Advised" default="Patient"] advised [textarea name="variable_1" default=""].
Additional Signs/Symptoms Reported: [textarea name="s" size = 100 default=" "]

History: 
Onset: [text name="O" size = 100 default=" "]
Allergies: Obtained as noted.
Medications: Obtained as noted.
Past Medical History: Obtained as noted.
Events Surrounding Condition: [textarea name="e" size = 100 default="None Noted"]

Assessment:
[select name="variable_1" value="CBA|Unresponsive|CB,not    alert"]
Reason    for    IFT:    [text name="variable_4" default="sample text"]

RX:
[radio name="variable_1" value="BLS|ALS"]

IFT    Orders:
[checkbox name="variable_1" value="IV    monitoring|Fluids|Hemodynamic    Monitoring|Zofran|other"]
[textarea name="variable_4" default="sample text"]

Transport:
[checkbox name="pe_trans_check" value="In the supine position|In the semi-fowlers position|Secured to stretcher via 5 seatbelts|Secured in airway seat via shoulder/lap belt.| Transported lights/sirens.|Non-Emergency."]

Patient transported to: [select name="Transport" value="No    Transport|Brattleboro Memorial Hospital|Grace Cottage Hospital|Pine Heights of Brattleboro|Dartmouth Hitchcock Medical Center|Albnay Medical Center|Hartford Hospital|Springfield Hospital|Baystate Medical Center, Springfield|Baystate Medical Center, Franklin|Brattleboro Retreat|Southern VT Medical Center|The    Cheshire    Medical    Center|Yankee    Dialysis|Other"][text    name="other"    size=100    default"]
Changes During Transport:
[text    name="other"    size=100    default"]
Destination: Upon arrival at destination, patient was transferred from the [select name="tx2" value="stretcher|No    Transport"] to the [select name="tx3" value="hospital bed|Chair|Standing|No    Transport"] via [select name="tx4" value="sheet pull|stand    &    Pivot|No    Transport"].  Once on the [select 
name="tx5" value="hospital bed|bed|chair|Standing|No    Transport"], patient care was transferred to the destination staff in stable condition.

Narrative:
[textarea name="variable_6" default="sample text"]

Signatures:[checkbox name="Variable_3" value="Signature obtained from PT|Signature obtained from patients legal gaurdian or parent|Signature obtained from RN in lieu of patient due to current condition|Signature obtained from RN for patient acceptance and transfer of care"]

Crew returned in service without further incident.
Provider: Hackler,    NRAEMT


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