MH Transfers

Arrived to [select name="Arrived-to" value="CMMC|St. Mary's|Cancer center at PenBay|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 report from [textarea name="Brief-report" default="RN- Brief report"] Pt is going to [select name="variable_1" value="Bella Point|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|discharge back to current place of residence|wound care|cancer appointment|palliative care|hospice care|appointment|OTHER"].

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

Crew Found pt [select name="variable_1" value="laying semi fowlers in bed|supine in bed|sitting in their wheel chair|sitting in recliner|sitting in stationary cahir|walking around in room|walking to stretcher in hall|OTHER"]. Pt is alert and oriented to baseline per facility which is [checkbox name="AVPU" value="alert and oriented times 4|alert and oriented to self, place, and situation|alert and oriented to self and place|alert and oriented to self only|arousable to voice|arousable to pain|completely 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 and breathing without dificulty. Skin is warm, dry and color appropriate. Pt moves extremities as appropriate for pt.
|is a hospice patient and is not well at baseline. Pt is deteriorating along expected trend. Pt has palpable ir/regular pulses in _____ and is breathing spontaneously at a rate of ____ ir/reguarly. Skin is ----- and cap refill is -----. Crew has written confirmation of a DNR.|is acutely unwell with recent deterioration and is not appropriate for discharge, transport is being canceled for pt benefit and will have to be rescheduled. 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 transport. Pt continues to refuse transport. Pt signed refusal of their own free will. Dispatch notified and crew returned to service without incident. |OTHER"]

Pt was transferred to stretcher 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 transferred between facility, stretcher, and onboard as appropriate without need for titration.

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

On arrival to facility pt was transferred 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 facility staff.|In hall report, paperwork, including any hard scripts, and care given to facility staff.|Pt left with facility staff at bedside.|Bed lowered to lowest position with rails raised and call bell within reach after pt was taught how to use it.|Report, paperwork, belongings, and care given to family. Family members verbilized understanding that 911 could be called at anytime for change in condition.|Family educated on home oxygen concentrator, base practice for nasal canula use, and portable oxygen cylender use. Family was able to verbilize and demonstrate appropraite understanding on equipment and appropraite use.|All questions where answered to the best of crews ability.|OTHER"]

Crew returned to service without incident. 

Signed by-