I-PASS – Standardized Patient Hand Offs (Verbal or Otherwise)

Illness Severity: [textarea name="illness_severity" default="stable, watcher, unstable"]
Patient Summary: [textarea name="patient_summary" default="summary statement, events leading up to admission, hospital course, ongoing assessment, plan"]
Action List: [textarea name="action_list" default="to do list, timeline and ownership"]
Situation Awareness and Contingency Planning: [textarea name="situation_awareness" default="know what is going on, plan for what might happen"]
Synthesis by Receiver: [textarea name="synthesis" default="receiver summarizes what was heard, asks questions, restates key action/to do items"]
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).isNot('')"]
[link url="https://www.ncbi.nlm.nih.gov/pubmed/22232313" memo="#1"] Reference: Starmer AJ, Spector ND, Srivastava R, Allen AD, Landrigan CP, Sectish TC; I-PASS Study Group. Pediatrics. 2012 Feb;129(2):201-4[/conditional]
Illness Severity:

Patient Summary:

Action List:

Situation Awareness and Contingency Planning:

Synthesis by Receiver:

display/hide references

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.17, 8 form elements, 14 boilerplate words, 5 text areas, 1 checkboxes, 1 links, 1 conditionals, 6 total clicks
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