LEW BLS transfers

Arrived to [select name="Arrived-to" value="CMMC.|St. Mary's.|Cancer center at CMMC|Bolster Heights|Chapman House|Clover|D'Youville|pt home|Hospice house|Lamp Memory Care|Marshwood|Montello Manor/ Commons|Odd Fellows|Sarah Frye|Schooner|The Meadows|Woodlands|OTHER"].
Got reprot from [textarea name="Breif-reprot" default="RN- Brief report"] Pt is going to [select name="variable_1" value="Bolster Heights|Chapman House|Clover|D'Youville|Home|Hospice house|Lamp Memory Care|Marshwood|Montello Manor/ Commons|Odd Fellows|Sarah Frye|Schooner|The Meadows|Woodlands|CMMC.|St. Mary's.|Cancer center at CMMC
|OTHER"] for [select name="Reason" value="rehab|dischage back to place of residence|wound care|cancer appointment|palitive care|hospice care|appointment"]

Ambulance transport is medically necessary due to [text name="variable_1" default="Medical necessity"]. 

Crew Found pt [select name="variable_1" value="laying semifowlers in bed|Supine in bed|Sitting in a chair|walking around in room|walking to strecher in hall|OTHER"]. Pt is alert and oriented to baseline per facitily wich is [checkbox name="APVU" value="alert and orietnted times 4|alert and oriented to self, place, and situation|alert and orinted to self and place|alert and orietned to self only|arousable to voice|arousable to pain|completly unresponsive"]. Pt complains of [text name="variable_1" default="Complaint"]. Pt [checkbox name="variable_1" value="is at reported baseline and is in no apparent distress. PT has an open and patient airway, bilateral chest rise and fall, no noted cyanosis. Skin is warm, dry and color appropriate. Pt moves extremities as appropriate for pt.
|is a hospice paitent and is not well at baseline. Pt is deteriorting within individaul baseline. Pt has palpable ir/regular pulses in _____ and is breathing spontaniously at a rate of ____ ir/reguarly. Crew has writen confimation of a DNR.|is acutly unwell with recent deteriaration and is not appropriate for discharge, transport is being canceled for pt benefit and will have to be reschedualed. Pt resents with DESCRIPTION|Pt is refusing transport. Pt is aox4 and can legally refuse transport. Pt educated by both crew and sending facility of risk of not being transported and benefits of transprot. Pt contiunes to refuse trasport. Pt signed refusal of thier own free will. Dispatch notified and crew returned to service without incedent. |OTHER"]

Pt was transfered to strecher via [checkbox name="variable_1" value="2 provider drawsheet|3+ provider drawsheet|assisted self scoot|assisted stand and pivot|assisted walk|unassisted walk|OTHER"] and made comfortable and secured as appropriate. 

Pt is on [text name="variable_1" default="---LPM o2 via NC"] at baseline. O2 tranfered between facility, stretcher, and onbaord as appropraite without need for titration.

In unit pt was monitored as recoreded and [checkbox name="variable_1" value="remained stable with no new complaints|remained stable and complained about discomfort due to strecher, attempted to make pt comfortable by adjusting unit tempiture, strecher position, pt positioning, and emotional support|remained stable but deveopled a complaint of -----|became unstable- DESCRIBE|OTHER"]. Pt [checkbox name="variable_1" value="was fairly talitive|was quiet but answers questions apropriatly|was on their phone|was at known baseline with no change in activity|attempted to rest comfortabley with their eyes closed, with consistant chest rise and fall, pt remained easily arousable|OTHER"].

On arrival to facility pt was trasfered from stretcher to bed via  [checkbox name="variable_1" value="2 provider drawsheet|3+ provider drawsheet|assisted self scoot|assisted stand and pivot|assisted walk|unassisted walk|OTHER"] and made comfortable. [checkbox name="variable_1" value="Bedside report, paperwork, including any hard scripts, and care given to faciltiy staff.|In hall report, paperwork, including any hard scripts, and care given to faciltiy staff.|Pt left with facility staff at bedside.|Bed lowered to lowest postion with rails raised and call bell within reach after pt was taught how to use it.|OTHER"]

Crew retured to service without incident. 

Signed by- 
Arrived to .
Got reprot from
Pt is going to for

Ambulance transport is medically necessary due to .

Crew Found pt . Pt is alert and oriented to baseline per facitily wich is . Pt complains of . Pt

Pt was transfered to strecher via and made comfortable and secured as appropriate.

Pt is on at baseline. O2 tranfered between facility, stretcher, and onbaord as appropraite without need for titration.

In unit pt was monitored as recoreded and . Pt .

On arrival to facility pt was trasfered from stretcher to bed via and made comfortable.

Crew retured to service without incident.

Signed by-

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.73, 15 form elements, 98 boilerplate words, 3 text boxes, 1 text areas, 7 checkboxes, 4 drop downs, 50 total clicks
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