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=""]
Dispatch: Who responded? How did you responded, emergently or non-emergently? Where did you respond? & What did you respond for?
was dispatched and responded to the above location for


Arrival: How did you discover the patient? What condition were they in? Did patient access require additional resources?


Chief Complaint: What did the patient/family/bystander tell you was wrong? & How long?



History: Current history of illness or injury. Pertient medical history.


Assessment: Utilize ESO Assessment Tab. Highlight significant findings.


Rx (Treatment): Utilize ESO Flowchart. Highlight significant treatments. Justify if needed. Document Medical Control orders here.


Transport: 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.


Document patient's refusal statement here. Describe provider education for refusal.

Include any issues that occured during the call.

Medical Necessity Statement: SmartDoc Solutions Copy and Paste medical necessity statement here. Emergency Responses require one (1) statement and number. Non-Emergency Responses require two (2) statements and numbers.

Result - Copy and paste this output:

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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