ePCR samples

DISPATCH: Unit [select name="unit" value="113|455|456|457|458"] Call Sign [select name="callsign" value="701|702|703|704|705"] Dispatched by [checkbox name="variable_1" value="Northstar Dispatch|Fayette 911|Fayette 911/Northstar"][text name="other" default=" "] Priority [select name="variable_3" value="1|2|3|4|5|Not Given"] for[text name="variable_1" default=" "] to [text name="variable_2" default=" "] at [text name="variable_3" default=" "] [pre arrival instructions to crew][text name="prearrivalinstocrew" default=" "]

RESPONSE: Unit responded from [checkbox name="variable_2" value="Marion Base|Fayette Base|Northwest Medical Center"][text name="variable_1" default=" "] [checkbox name="variable_3" value="emergency|non-emergency"] [checkbox name="variable_4" value="immediate|non-immediate"] response with [checkbox name="variable_5" value="lights and siren|no lights and siren"]

ARRIVAL:
[checkbox name="ARRIVED" value="On scene without incident and no change in response mode|Canceled enroute|Canceled onscene"] applied PPE of [checklist name="PPE" value="gloves|surgical mask|Gown|Googles/face shield|N95"]
SCENE/GENERAL IMPRESSION:
[text name="AGE" default=" "]

Scene Summary. The Scene Summary details what happened when the crew arrived on scene.  
[textarea name="variable_1" default="sample text"]

[checkbox name="sex" value="MALE|FEMALE"][checkbox name="pe_general_check" value="WELL DEVELOPED/WELL NOURISHED|WELL APPEARING|IN NO ACUTE DISTRESS|MALNOURISHED|IN ACUTE DISTRESS|OBESE|APPEARS ILL|APPEARS FRAIL"][textarea name="SCENEIMP" default=" "]
INITIAL ABC's:
-AIRWAY: [checkbox name="airway" value="NORMAL|AIRWAY OPEN|AIRWAY PATENT|NO AIRWAY OBSTRUCTIONS|AIRWAY POSITIONED TO OPEN|AIRWAY NOT PATENT|OBSTRUCTIONS TO AIRWAY|REQUIRES AIRWAY ADJUNCT|REQUIRES ADVANCED AIRWAY|REQUIRES ARTIFICIAL VENTILATION"][text name="airway" default=" "]

-Breathing: [checkbox name="breathing" value="NORMAL|BREATHING SPONTANEOUSLY|BREATHING REGULAR|ADEQUATE RESPIRATIONS|APPROPRIATE TIDAL VOLUME|NOT SPONTANEOUSLY BREATHING|IRREGULAR RESPIRATIONS|INADEQUATE RESPIRATIONS|INADEQUATE TIDAL VOLUME"][text name="breathing" default=" "]

-CIRCULATION: [checkbox name="circulation" value="NORMAL|NO OBVIOUS BLEEDING|PULSES INTACT|SKIN COLOR APPROPRIATE|NO LIFE THREATS TO CIRCULATION|HEMORRHAGE PRESENT|HEMORRHAGE CONTROLLED|ARTERIAL TOURNIQUET APPLIED|PULSES NOT INTACT|SKIN COLOR NO APPROPRIATE|LIFE THREATENING CONCERNS WITH CIRCULATION"][text name="ros_constitutional" default=" "]


CC:[textarea="CC" default=" "]

HPI:[textarea name="hpi" default=" "]
ALLERGIES:[checkbox name="allergies_check" value="NKDA|SULFA|CODEINE|MORPHINE|PCN"][textarea name="allergies" default=" "]
MEDICATIONS:
[textarea name="MEDICATIONS" default=" "]

PMHx:
[checkbox name="pmhx" value="CARDIAC|COPD|ASTHMA|DIABETES|HYPERTENSION|SEIZURES|BEHAVIORAL/AMS|CVA/TIA|CANCER"][textarea name="pmhx" default=" "]
LAST INTAKE:[textarea name="LASTINTAKE" default=" "]
EVENTS:
[textarea name="EVENTS" default=" "]


REVIEW OF SYSTEMS:

-CONSTITUTIONAL: [checkbox name="ros_constitutional_check" value="NORMAL|NO FEVER|NO CHILLS|NO WEAKNESS|NO FATIGUE|FEVER|CHILLS|WEAKNESS|FATIGUE"][text name="ros_constitutional" default=" "]
-HEENT: [checkbox name="ros_heent_check" value="NORMAL|NO VISION CHANGES|NO EAR PAIN|NO NASAL CONGESTION|NO SORE THROAT|NO COUGH"][text name="ros_heent" default=" "]
-CARDIOVASCULAR: [checkbox name="ros_cardio_check" value="NORMAL|NO CHEST PAIN|NO PALPITATIONS|NO SWELLING OF EXTREMITIES|CHEST PAIN|PALPITATIONS|SWELLING OF EXTREMITIES"][text name="ros_cardio" default=" "]
-RESPIRATORY: [checkbox name="ros_resp_check" value="NORMAL|NO SHORTNESS OF BREATH|NO HEMOPTYSIS|NO DYSPNEA|SHORTNESS OF BREATH|HEMOPTYSIS|DYSPNEA"][text name="ros_resp" default=" "]
-GI: [checkbox name="ros_gi_check" value="NORMAL|NO CHANGE IN APPETITE|NO ABDOMINAL PAIN|NO HEMATEMESIS|CHANGE IN APPETITE|NO N/V/D|ABDOMINAL PAIN|HEMATEMESIS|NAUSEA|VOMITING|DIARRHEA"][text name="ros_gi" default=" "]
-GU: [checkbox name="ros_gu_check" value="NORMAL|NO URINARY FREQUENCY|NO URINARY URGENCY|NO DYSURIA|NO HEMATURIA|NO LEAKAGE OF URINE|URINARY FREQUENCY|URINARY URGENCY|DYSURIA|HEMATURIA|LEAKAGE OF URINE"][text name="ros_gu" default=" "]
-MSK: [checkbox name="ros_msk_check" value="NORMAL|NO BACK PAIN|NO JOINT PAIN|NO MUSCLE ACHES|NO GENERALIZED MUSCLE PAIN|NO NECK PAIN|BACK PAIN|JOINT PAIN|MUSCLE ACHES|GENERALIZED MUSCLE PAIN|NECK PAIN"][text name="ros_msk" default=" "]
-SKIN: [checkbox name="ros_skin_check" value="NORMAL|NO RASH|NO BRUISING|NO LESIONS|NO ITCHING|RASH|BRUISING|LESIONS|ITCHING"][text name="ros_skin" default=" "]
-NEURO: [checkbox name="ros_neuro_check" value="NORMAL|NO HEADACHE|NO DIZZINESS|NO SYNCOPE|NO LOSS OF CONSCIOUSNESS|HEADACHE|DIZZINESS|SYNCOPE|LOSS OF CONSCIOUSNESS"][text name="ros_neuro" default=" "]
-PSYCH: [checkbox name="ros_psych_check" value="NORMAL|DENIES SUICIDAL/HOMICIDAL IDEATIONS|NO HALLUCINATIONS|NO DEPRESSION|NO ANXIETY|SUICIDAL/HOMICIDAL IDEATIONS|HALLUCINATIONS|DEPRESSED|ANXIOUS"][text name="ros_psych" default=" "]
-ENDOCRINE: [checkbox name="ros_endo_check" value="NORMAL|NO HEAT/COLD INTOLERANCE|NO EXCESSIVE THIRST|NO POLYURIA|HEAT INTOLERANCE|COLD INTOLERANCE|EXCESSIVE THIRST|POLYURIA"][text name="ros_endo" default=" "]
-HEMATOLOGIC: [checkbox name="ros_heme_check" value="NORMAL|NO EXCESSIVE BRUISING|NO EXCESSIVE BLEEDING|EXCESSIVE BRUISING|EXCESSIVE BLEEDING"][text name="ros_heme" default=" "]

DIAGNOSTIC:
-TIME:[text name="TIME" default=" "]
-BLOOD PRESSURE:[text name="pe_bp" default=" "]
-PULSE:[text name="pe_pulse" default=" "]
-RESP:[text name="Resp" default=" "]
-SPO2:[text name="pe_spo2" default=" "]
-CO2:[text name="CO2" default=" "]
-BGL:[text name="pe_bgl" default=" "]
-TEMP:[text name="TEMP" default=" "]
-EKG FINDINGS: [checkbox name="EKG" value="SINUS RHYTHM|SINUS BRADYCARDIA|SINUS TACHYCARDIA|SINUS ARRHYTHMIA|WANDERING ATRIAL PACEMAKER|MULTIFOCAL ATRIAL TACHYCARDIA|AFIB|AFIB W/RVR|SUPRAVENTRICULAR TACHYCARDIA|ATRIAL FLUTTER|JUNCTIONAL RHYTHM|FIRST DEGREE AV BLOCK|SECOND DEGREE TYPE 1|SECOND DEGREE TYPE 2|3RD DEGREE BLOCK|IVR|ACCELERATED IVR|VTach|VFIB|ASYSTOLE|PEA|TORSADES|W/PVC'S|W/PAC'S|W/PJC'S"][text name="ros_heme" default=" "]


-HEENT: [checkbox name="pe_heent_check" value="NORMOCEPHALIC|ATRAUMATIC|PERRLA|WHITE SCLERA|CONJUNCTIVA PINK/RED|EARS PATENT|NO BLEEDING|BLEEDING|POSITIVE HALO TEST|NEGATIVE HALO TEST|DRY MUCOUS MEMBRANES|EXTRA SALIVATION|NORMAL MUCOUS|NORMAL PHARYNX|NO TRAUMA TO MOUTH|TRAUMA TO FACE|TRAUMA TO MOUTH"][text name="pe_heent" default=" "]
-CARDIOVASCULAR: [checkbox name="pe_cardio_check" value="REGULAR RATE AND RHYTHM|NO ST ELEVATION|NO JUGULAR VEIN DISTENTION|NO EDEMA|PERIPHERAL PULSES INTACT|NO CYANOSIS|IRREGULAR RATE|IRREGULAR RHYTHM|ST ELEVATION PRESENT|JVD PRESENT|EDEMA PRESENT|NO PERIPHERAL PULSES|CYANOSIS PRESENT|BLEEDING"][text name="pe_cardio" default=" "]
-RESPIRATORY: [checkbox name="pe_resp_check" value="CLEAR TO AUSCULTATION BILATERALLY|NO RALES, RHONCHI, WHEEZES|NO RETRACTIONS|NO ACCESSORY MUSCLE USE|NO STRIDOR|WHEEZING|UPPER RESPIRATORY CONGESTION"][text name="pe_resp" default=" "]
-GI:[checkbox name="pe_gi_check" value="atraumatic.|BS PRESENT IN ALL 4 QUADRANTS|ABDOMEN SOFT/NON-TENDER TO PALPATION|NON-DISTENDED|NO RIGIDITY|NO GUARDING|NO MASSES|NORMAL|TRAUMA PRESENT|TENDER ABDOMEN|RIGID ABDOMEN|DISTENDED ABDOMEN|GUARDING PRESENT|MASSES PRESENT"][text name="pe_gi" default=" "]
-MSK: [checkbox name="pe_msk_check" value="NORMAL RANGE OF MOTION|NO PAIN ON PALPATION|STRENGTH 5/5 IN ALL EXTREMITIES|ABNORMAL RANGE OF MOTION|PAIN ON PALPATION|STRENGTH NOT PRESENT IN ALL EXTREMITIES"][text name="pe_msk" default=" "]
-SKIN: [checkbox name="pe_skin_check" value="NO RASH|NO LESION|NO DISCOLORATION|PINK|WARM|DRY|PALE|COOL|CYANOTIC|FLUSHED|CLAMMY|HOT"][text name="pe_skin" default=" "]
-NEURO: [checkbox name="pe_neuro_check" value="GROSSLY ORIENTED X 4|GAIT NORMAL|SENSATION INTACT|NORMAL REFLEXES|SMILE NORMAL|SPEECH NOT SLURRED|NEURO NOT GROSSLY INTACT|GAIT ABNORMAL|SENSATION ABSENT|NO REFLEXES|SMILE NOT SYMMETRICAL|SLURRED SPEECH"][text name="pe_neuro" default=" "]
-PSYCH: [checkbox name="pe_psych_check" value="PLEASANT, CALM, AND COOPERATIVE|JUDGEMENT AND INSIGHT INTACT|HAS A PLAN MADE|UNDERSTANDS TREATMENT|THOUGHT PROCESS NORMAL|NORMAL AFFECT|UNPLEASANT|NOT CALM|UNCOOPERATIVE|DOES NOT HAVE A PLAN|DOES NOT UNDERSTAND TREATMENT"][text name="pe_psych" default=" "]
-HEMATOLOGIC: [checkbox name="pe_heme_check" value="NO TENDERNESS OR MASSES PALPATED|NO BRUISES|NO BLEEDING|TENDERNESS|BRUISING|BLEEDING"][text name="pe_heme" default=" "]

TREATMENT:[textarea name="Treatment" default=" "]

HOSPITAL ACTIVATIONS: [checkbox name="pe_act_check" value="ATCC CONTACTED FOR STROKE|ATCC CONTACTED FOR TRAUMA|THROMBOLYTIC CHECKLIST COMPLETED|HISTORIAN INFORMATION AND CONTACT NUMBER GATHERED"][text name="pe_act" default=" "]

TRANSPORT: [checkbox name="pe_trans_check" value="SECURED TO STRETCHER|3 STRAPS|LOADED FOR TRANSPORT|EMERGENCY|NON EMERGENCY|EMERGENCY DOWNGRADED TO NON EMERGENCY|NON EMERGENCY UPGRADED TO EMERGENCY|PATIENT REFUSED TRANSPORT|AMA|PATIENT TREATED AND RELEASED|NO TRANSPORT|LIFT ASSIST ONLY|TRANSPORTED TO FLOWERS HOSPITAL|TRANSPORTED TO SOUTHEAST HEALTH"][text name="pe_trans" default=" "]

TRANSPORT/RE-ASSESSMENT/DISPOSTION: [checkbox name="pe_rep_check" value="VERBAL REPORT TO NURSE|PATIENT BELONGINGS LEFT WITH NURSE|IMPROVEMENT IN PATIENT CONDITION|DECLINE IN PATIENT CONDITION|NO CHANGE IN PATIENT CONDITION|NO DETERIORATION|NO DEVIATION FROM INITIAL ASSESSMENT"][text name="pe_rep" default=" "]

REPORT WRITER:[checkbox name="pe_RW_check" value="Jeffery P Barnes, NRP AL Lic 8832718 "][text name="RW" default=" "]