Madison County EMS | Narrative Assistant
Dispatch: [comment memo="Who responded? How did you responded, emergently or non-emergently? Where did you respond? & What did you respond for?"] [select name="variable_1" value="EC1|EC2|EC3|EC4|EC5|EC6|EC7|EC8|EC9|EC10|EC11|EC12|EC13|EC14"] was dispatched and responded [select name="variable_2" value="emergently|non-emergently|"] to the above location for [checkbox name="variable_3" value="a non-emergency interfacility transfer|an emergency interfacility transfer"] [textarea name="variable_4" default=""] Arrival: [comment memo="How did you discover the patient? What condition were they in? Did patient access require additional resources?"] [textarea name="variable_5" default=""] Chief Complaint: [comment memo="What did the patient/family/bystander tell you was wrong? & How long?"] [textarea name="variable_6" default=""] [checkbox memo="" name="VAC333333" value="Pain Statement:"][conditional field="VAC333333" condition="(VAC333333).is('Pain Statement:')"] The patient states their pain began while [text name="variable_41" default="O"]. [text name="variable_42" default="P"] makes the pain [select name="variable_43" value="worse|better"]. The patient describes the pain as [text name="variable_44" default="Q"]. The patient advises it [text name="variable_45" default="R"]. Advising it is a [select name="variable_46" value="1|2|3|4|5|6|7|8|9|10"]/10 in severity. The patient advised the pain has lasted [text name="variable_47" default="T"].[/conditional] History: [comment memo="Current history of illness or injury. Pertient medical history."] [textarea name="variable_7" default=""] Assessment: [comment memo="Utilize ESO Assessment Tab. Highlight significant findings."] [textarea name="variable_8" default=""] Rx (Treatment): [comment memo="Utilize ESO Flowchart. Highlight significant treatments. Justify if needed. Document Medical Control orders here."] [textarea name="variable_9" default=""] Transport: [comment memo="Where did you take the patient? How did the patient get to and from the ambulance? How did you transport? Patient's condition at destination. Details of patient care transfer."] [textarea name="variable_10" default=""] [checkbox memo="Document patient's refusal statement here. Describe provider education for refusal." name="VAC111111" value="Refusal:"][conditional field="VAC111111" condition="(VAC111111).is('Refusal:')"][comment memo=""] [textarea name="variable_11" default=""][/conditional] [checkbox memo="Include any issues that occured during the call." name="VAC222222" value="Exceptions:"][conditional field="VAC222222" condition="(VAC222222).is('Exceptions:')"][comment memo=""] [textarea name="variable_12" default=""][/conditional] Medical Necessity Statement: [link url="https://mnc.smartdocsolutions.com/node" memo="SmartDoc Solutions"] [comment memo="Copy and Paste medical necessity statement here. Emergency Responses require one (1) statement and number. Non-Emergency Responses require two (2) statements and numbers."] [textarea name="variable_13" default=""]
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Sandbox Metrics: Structured Data Index 0.35, 37 form elements, 21 boilerplate words, 5 text boxes, 10 text areas, 4 checkboxes, 4 drop downs, 1 links, 10 comments, 3 conditionals, 24 total clicks
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