SAFR DCHART

[comment memo="This is an interactive patient care report template. Fill it out/make edits as needed, then click Calculate Result at the bottom and copy/paste into your narrative section. You can finishing editing it there. If you have any questions, DM Kaia D. F-405 "]

DISPATCH: [select name="level_of_care" value="Squad|Medic"] [text name="unit" default="54"] is dispatched to [text name="address" default="address"] for [text name="dispatch" default=""] and responds [select name="response_type" value="non-emergently|emergently"] with [conditional field="level_of_care" condition="(level_of_care).is('Squad')"]a BLS[/conditional][conditional field="level_of_care" condition="(level_of_care).is('Medic')"]an ALS[/conditional] crew of [text name="number_of_crew" default="4"].[textarea name="additional_notes" default=""]

CHIEF COMPLAINT: [text name="chief_complaint" default="''"]

HISTORY: (PMH, Rx, Allergies As Noted) - [textarea name="history" size = 55 default="Pt states  Denies "]

Scene Arrival: [textarea name="scene" default="Upon arrival,   Pt is found "]

ASSESSMENT:
General: [textarea name="appearance" default="A/O x4. Interacting with EMS appropriately; well appearing; not acutely distressed. "]
Airway/Breathing: [textarea name="airway" default="No immediate concerns. Airway is patent and clear of obstructions. Normal and adequate rate/depth."] [checkbox name="lung_sounds" value="Lung sounds present and clear bilaterally."]
Circulation: [textarea name="circulation" default="No immediate concerns. No major hemorrhage. Equal radial pulses bilaterally. "]
CNS: [textarea name="CNS" default="Speech is not slurred. PMS grossly intact in all 4 extremities. Gait is steady. "]
Psych: [textarea name="psych" default="No reported recent or active suicidality or homicidal ideations. No reported recent or active visual/auditory disturbances. "]
GI/GU: [textarea name="GIGU" default="No nausea or vomiting. No changes in bowel or urine reported. "]

[checkbox name="physical_exam" value="Physical Exam:"][conditional field="physical_exam" condition="(physical_exam).is('Physical Exam:')"]
Head: [textarea name="head" default="No noted pain or trauma. No facial droop. "][checkbox name="pupils" value="Pupils equally round and reactive."]
Neck: [textarea name="neck" default="No noted pain or trauma. No JVD. Trachea midline. "]
Chest: [textarea name="chest" default="No noted pain or trauma. Equal rise and fall. Breath sounds CTA bilaterally. "]
Back: [textarea name="back" default="No noted pain or trauma. "]
Abdomen: [textarea name="abd" default="No noted pain or trauma. Soft, flat, non-tender. "]
Pelvis: [textarea name="pelvis" default="No noted pain or trauma. Stable. "]
Extremities: [textarea name="extremities" default="No noted pain or trauma. No clubbing, cyanosis or edema. "]
Skin: [textarea name="skin" default="Normal tone for ethnicity, warm, dry. "]

[/conditional]Vitals: (As Noted) [textarea name="vitals" default=" "][checkbox name="ekg" value=" 12-lead ECG acquired and transmitted."]

Rx/Treatment: 
[textarea name="treatment" default="No treatments indicated or performed."]

TRANSPORT: 
[textarea name="transport" default="Patient assisted to cot and secured with all straps in position of comfort. Transported non-emergently with pre-arrival notification made enroute. Vitals are reassessed throughout transport and pt's condition remains stable. "]

Hospital Arrival:
[textarea name="hospital" default="Upon arrival to ED handoff report given to Nurse NAME at bedside. Nurse signs PCR. Care is handed to ED and EMS restocks/clears without incident."]

[checkbox name="extra" value="EXTRA SECTION:"]
[conditional field="extra" condition="(extra).is('EXTRA:')"][textarea name="extra_text" default="Misc./Extra Events"][/conditional]
[comment memo="Enter Provider Name/Level"]
[text name="provider_name_and_level" default="John Doe, EMT"]