Rural Med DA CHART 2024

[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.

NOTE: Nothing on this website saves. Copy/Paste the template into your chart early on to avoid losing any work."]

DISPATCH: [select name="level_of_care" value="Rural Med|Medic"] [text name="unit" default=" UNIT "] is dispatched to [text name="address" default="address"] via  MEDCOM 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('Rescue')"]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="2"].[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 hx of "]

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 EKG acquired and transmitted to ED."]

Rx/Treatment: 
[textarea name="treatment" [checkbox name="No treatments." value="No treatmeants indicated or preformed."]

TRANSPORT: 
[textarea name="transport" default="Patient assisted to cot and secured with all straps in position of comfort. Transported non-emergently to ED  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 crew restocks/clears without incident."]

Medical Necessity:   
[textarea name="Medical" default="Patient required an  ambulance transport due to..."]

Signatures:
[textarea name="signatures" default="Patient authorization was signed by..."]

[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-B"]
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.

NOTE: Nothing on this website saves. Copy/Paste the template into your chart early on to avoid losing any work.


DISPATCH: is dispatched to via MEDCOM for and responds with crew of .


CHIEF COMPLAINT:

HISTORY: (PMH, Rx, Allergies As Noted) -


Scene Arrival:


ASSESSMENT:
General:

Airway/Breathing:

Circulation:

CNS:

Psych:

GI/GU:


Vitals: (As Noted)


Rx/Treatment:


TRANSPORT:


Hospital Arrival:


Medical Necessity:


Signatures:




Enter Provider Name/Level

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.19, 43 form elements, 43 boilerplate words, 6 text boxes, 24 text areas, 5 checkboxes, 2 drop downs, 2 comments, 4 conditionals, 37 total clicks
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