Interfacility SOAP Narrative Template

[comment memo="S:Subjective. What you were told by the facility, patient, and dispatch leading to you being sent to the call" memo_style="bold"]
[text name="TWUnit" default="TW22"] dispatched to a [select name="Emergent" value="Non-Emergent|Emergent"] [select name="TransportType" value="BLS|MICU|ALS|Wait-And-Return|ITA"] transport of a [text name="Age-Sex" default="Age/Sex"] C/C [text name="ChiefComplaint" default="ChiefComplaint"] going from [text name="Origin" default="Origin"] to [text name="Destination" default="Destination"] for [text name="Typeofcareorprocedure" default="Procedure/Care"] unavailable at sending facility. Pt requires BLS transport with EMT attendant because pt [conditional][/conditional][checkbox name="PCSReasons" value="Is bed confined, unable to ambulate, unable to get out of bed without assistance, and unable to sit in a chair or wheelchair|is unable to tolerate seated position for time needed to transport|has an altered level of consciousness requiring monitoring|has contractures|is unable to sit in a chair/wheelchair due to decubitus ulcers or other wounds|is morbidly obese, requiring additional personnel and equipment to safely handle the patient|Requires special handling, isolation, and infection control precautions|Is a danger to self or others due to SI/HI|Has a need or possible need for restraint|Has DVT requiring elevation of lower extremity|Requires oxygen and is unable to self administer|Has Orthopedic device in place requiring special handling in transit.|Is at risk of falling out of wheelchair or stretcher while in motion|Has moderate to severe pain on movement"][conditional][/conditional][comment memo="In the box below, explain what you may do as an EMT to justify the patient being in the back of the ambulance. If there isn't anything you can add, then leave the box blank.           Example: EMT also required during transfer to higher level of care to monitor patients' vital signs due to active infection and interventions that may be required." memo_style="bold"][conditional][/conditional]
[textarea name="TransportReason"][conditional][/conditional][comment memo="Report from nurse, patient, etc, timeline of events, onset, think OPQRST." memo_style="bold"][comment memo="Example: ED RN states pt came into the ED approximately 12 hours ago with 10/10 diffuse abdominal pain and vomiting, pt was found to have appendicitis, pt to transfer to facility A for speciality surgery, ED RN gave pt 4mg zofran at 1200 and dilauded at 1300 for pain with pain reduction to 4/10 and nausea decreased"][conditional][/conditional]
[textarea name="Report]
[comment memo="Medical History" memo_style="bold"]Hx:[textarea name="Hx" default=""]
[comment memo="Medications" memo_style="bold"]Meds:[textarea name="Meds" default=""]
[comment memo="Allergies" memo_style="bold"]ALLS:[textarea name="ALLS" default=""]
[comment memo="O:Objective. What you found while examining the patient. What you saw or heard." memo_style="bold"]
Pt presents to [text name="TWUnit" default="TW22"] crew [select name="Position" value="sitting|supine|prone|semi-fowlers|left-lateralrecumbent|right-lateralrecumbent"] in [comment memo="Where was the patient found? In an ED bed, what number? In the living room on a couch? What seat in the car in a car wreck?" memo_style="bold"][text name="FoundWhere"] Pt is [select name="AnO" value="A/Ox4|A/Ox3|A/Ox2|A/Ox1|Unconscious|Obtunded|Asleep|Sedated|Combative|Confused"] Skin [select name=Skin" value="PWD|Pale and Cool|Mottled|Cyanotic|Diaphoretic|Hot and Dry"] [text name="CP-SOB" default="Any CP/SOB?"] Vital Signs: [checkbox name="HR" value="HR:"][conditional field="HR" condition="(HR).is('HR:')"][text size="5"][/conditional] [checkbox name="BP" value="BP:"][conditional field="BP" condition="(BP).is('BP:')"][text size="7"][/conditional] [checkbox name="RR" value="RR:"][conditional field="RR" condition="(RR).is('RR:')"][text size="5"][/conditional] [checkbox name="SpO2" value="SpO2:"][conditional field="SpO2" condition="(SpO2).is('SpO2:')"][text size="5"][/conditional] [checkbox name="Temp" value="Temp:"][conditional field="Temp" condition="(Temp).is('Temp:')"][text size="5"][/conditional] [checkbox name="GCS" value="GCS:"][conditional field="GCS" condition="(GCS).is('GCS:')"][text size="5"][/conditional] [checkbox name="BGL" value="BGL:"][conditional field="BGL" condition="(BGL).is('BGL:')"][text size="5"][/conditional] [checkbox name="Pain" value="Pain:"][conditional field="Pain" condition="(Pain).is('Pain:')"][text size="5" default="/10"][text size="20"][/conditional][comment memo="Remember: Pain is a mandatory vital sign along with many others and everyone should have a pain level! Use NRS-11(0-10) or FACES if pt unable to articulate pain. Don't forget to include how the pain feels and where it is here as well as in your exam notes" memo_style="bold" memo_color="red"]
[comment memo="Select a checkbox for each area assessed and fill out your findings, if something was not assessable but pertinent to care for some reason, say why in the PLAN section." memo_style="bold"]
[checkbox name="Behavioral" value="Behavioral:"][conditional field="Behavioral" condition="(Behavioral).is('Behavioral:')"][textarea name="Behavioral" default=""][/conditional]
[checkbox name="HEENT" value="HEENT:"][conditional field="HEENT" condition="(HEENT).is('HEENT:')"][textarea name="HEENT" default=""][/conditional]
[checkbox name="Chest" value="Chest:"][conditional field="Chest" condition="(Chest).is('Chest:')"][textarea name="Chest" default=""][/conditional]
[checkbox name="LungSounds" value="LungSounds:"][conditional field="LungSounds" condition="(LungSounds).is('LungSounds:')"][textarea name="LungSounds" default=""][/conditional]
[checkbox name="Spine" value="Spine:"][conditional field="Spine" condition="(Spine).is('Spine:')"][textarea name="Spine" default=""][/conditional]
[checkbox name="Extremities" value="Extremities:"][conditional field="Extremities" condition="(Extremities).is('Extremities:')"][textarea name="Extremities" default=""][/conditional]
[checkbox name="Abdomen" value="Abdomen:"][conditional field="Abdomen" condition="(Abdomen).is('Abdomen:')"][textarea name="Abdomen" default=""][/conditional]
[comment memo="A:Assessment. What is wrong with the patient?" memo_style="bold"]
R/O [text name="RuleOut" default="What is wrong?"]
[comment memo="P:Plan. A chronological order of what you did. Example: Received report from RN, pt ambulated to TW22 stretcher with seatbelts in place and side rails secured, EXAM, VS, transport pt to destination, monitor pt VS,LOC, and airway for any changes or interventions required, pt reports decrease in pain to 4/10 when pillow placed under legs, pt transported to destination, care and report to RN, no changes, TW22 clear" memo_style="bold"]
[textarea name="Plan" default="What happened? Report from RN/PT/ETC, Exam, How were they moved to the stretcher, did they ambulate?, Where did they get transported to? Any report given during transport?"]
S:Subjective. What you were told by the facility, patient, and dispatch leading to you being sent to the call
dispatched to a transport of a C/C going from to for unavailable at sending facility. Pt requires BLS transport with EMT attendant because pt In the box below, explain what you may do as an EMT to justify the patient being in the back of the ambulance. If there isn't anything you can add, then leave the box blank. Example: EMT also required during transfer to higher level of care to monitor patients' vital signs due to active infection and interventions that may be required.
Report from nurse, patient, etc, timeline of events, onset, think OPQRST.Example: ED RN states pt came into the ED approximately 12 hours ago with 10/10 diffuse abdominal pain and vomiting, pt was found to have appendicitis, pt to transfer to facility A for speciality surgery, ED RN gave pt 4mg zofran at 1200 and dilauded at 1300 for pain with pain reduction to 4/10 and nausea decreased

Medical HistoryHx:

MedicationsMeds:

AllergiesALLS:

O:Objective. What you found while examining the patient. What you saw or heard.
Pt presents to crew in Where was the patient found? In an ED bed, what number? In the living room on a couch? What seat in the car in a car wreck? Pt is Skin Vital Signs: Remember: Pain is a mandatory vital sign along with many others and everyone should have a pain level! Use NRS-11(0-10) or FACES if pt unable to articulate pain. Don't forget to include how the pain feels and where it is here as well as in your exam notes
Select a checkbox for each area assessed and fill out your findings, if something was not assessable but pertinent to care for some reason, say why in the PLAN section.







A:Assessment. What is wrong with the patient?
R/O
P:Plan. A chronological order of what you did. Example: Received report from RN, pt ambulated to TW22 stretcher with seatbelts in place and side rails secured, EXAM, VS, transport pt to destination, monitor pt VS,LOC, and airway for any changes or interventions required, pt reports decrease in pain to 4/10 when pillow placed under legs, pt transported to destination, care and report to RN, no changes, TW22 clear

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.4, 86 form elements, 40 boilerplate words, 19 text boxes, 13 text areas, 16 checkboxes, 5 drop downs, 13 comments, 20 conditionals, 66 total clicks
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