SEFD project dont uses this one

DISPATCHED:
SEFD was dispatched via radio for a [text name="dispatch_1" default=" "] [select name="variable_age" value="Year old | Month old | Day old"][select name="dispatched_1" value=" Male | Female"]
DISPATCH DETERMIND CHIEF COMPLAINT:[text name="CC" size = 55 default=" "]

APPARATUS RESPONDED: 
[checkbox name="variable_5" value="C601.|C602.|B601.
|B602.|B603.|P601.|P603.|T601.|R601.|R602.|R603.|R604.|R605.|R606.|R607.|R608.|R609.|R610.|POV."][text name="variable_4" default=" "]

First Apparatus on scene:
[select name="variable_66" value="C601.|C602.|B601.
|B602.|B603.|P601.|P603.|T601.|R601.|R602.|R603.|R604.|R605.|R606.|R607.|R608.|R609.|R610.|POV."]

RESPONSE Mode: [checkbox name="RESPONSE_1" value="EMERGENT.|NONEMERGENT.|WITH LIGHTS/SIRENS.|WITH NO LIGHTS NO SIRENS.|NO LIGHTS NO SIRENS.|UPGRADED TO EMERGENT.|DOWNGRADED TO NONEMERGENT."][text name="RESPONSE" default=" "]

UPON ARRIVAL:
[textarea name="arrival_1" default=" "]

PATIENTS CHIEF COMPLAINT:[text name="CC" size = 55 default=" "]

NOI/MOI:
[textarea name="HX_OF_PRESENT_ILLNESS" default=" "]

PAST MEDICAL Hx:
[textarea name="pmhx" default=" "]

Medications:[checkbox name="variable_medicatios" value="None. | Insulin. | Hypertension medication. "][text name="variable_stuff" default=" "]

ALLERGIES:[checkbox name="allergies_check" value="NKDA.|PENICILLIN.|SULFA.|LATEX."][text name="allergies" default=" "]

[comment memo="***Ignore if no pain remember to delete***"]
Pain Assessment: 
Onset: [text name="O" size = 55 default=" ***When did it start. What were they doing*** "]
Provoking/Relieving Factors: [text name="P" size = 55 default=" ***What makes it feel better or worse*** "]
Quality/Described As: [text name="q" size = 55 default=" ***Describe the pain*** "]
Radiation: [text name="r" size = 55 default=" ***Where else does it go*** "]
Severity: [checkbox name="variable_severity" value="1 out of 10 :)|2 out of 10|3 out of 10|4 out of 10|5 out of 10 :(|6 out of 10|7 out of 10|8 out of 10|9 out of 10|10 out of 10 :{"][text name="s" size = default=" "]
Acute/Chronic condition: [text name="t" size =  default=" "] 
[comment memo="***Ignore if no pain remember to delete***"]

Patients positioning:
[checkbox name="variable_1" value="Supine or Dorsal Recumbent Position.|Fowler’s Position.|Tripod Position.|Seated position.|Prone Position.|Lateral Position.|Sims’ Position.|Lithotomy Position.|Trendelenburg’s Position.|Reverse Trendelenburg’s Position.|Knee-Chest Position."]

Initial ABC's:
-Airway: [checkbox name="airway" value="airway open.|airway patent.|no airway obstructions.|Normal.|airway positioned to open.|airway not patent.|obstructions to airway.|requires airway adjunct."][text name="airway" default=" "]

-Breathing: [checkbox name="breathing" value="breathing spontaneously.|breathing regular.|adequate respirations.|appropriate tidal volume.|no apparent life threats to breathing.|Normal.|not breathing spontaneously.|irregular respirations.|inadequate respirations.|inadequate tidal volume.|apparent life threats to breathing."][text name="breathing" default=" "]

-Circulation: [checkbox name="circulation" value="no obvious bleeding.|pulses intact.|skin color appropriate.|cap refill less than 2 seconds.|no life treats to circulation status.|Normal.|hemorrhage present.|hemorrhage controlled.|TQ applied.|pulses not intact.|skin color not appropriate.|cap refill more than 2 seconds.|life threatening concerns with circulation."][text name="ros_constitutional" default=" "]


Patients Signs and symptoms:

-Level of Consciousness: [checkbox name="loc" value="alert.|oriented.|Person.|Place.|Time. |Event.|disoriented. |arousable by verbal stimuli.|arousable by painful stimuli.|unresponsive."][text name="ros_loc" default=" "]

-Constitutional: [checkbox name="ros_constitutional_check" value="no fever.|no chills.|no weakness.|no fatigue.|no malaise.|fever.|chills.|weakness.|malaise."][text name="ros_constitutional" default=" "]

-HEENT: [checkbox name="ros_heent_check" value="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="No chest pain|no palpitations.|no swelling of extremities.|Normal.|chest pain.|palpitations.|swelling of extremities."][text name="ros_cardio" default=" "]

-Respiratory:[checkbox name="ros_resp_check" value="No shortness of breath.|no hemoptysis.|no dyspnea.|Normal.|shortness of breath.|hemoptysis.|dyspnea."][text name="ros_resp" default=" "]

-GI: [checkbox name="ros_gi_check" value="no change in appetite.|no abdominal pain.|no hematemesis.|Normal.|change in appetite.|abdominal pain.|hematemesis.|Nausea.|vomiting.|diarrhea."][text name="ros_gi" default=" "]

-GU: [checkbox name="ros_gu_check" value="no urinary frequency.|no urinary urgency.|no dysuria.|no hematuria.|no leakage of urine.|Normal.|urinary frequency.|urinary urgency.|dysuria.|hematuria.|leakage of urine."][text name="ros_gu" default=" "]

-Muscle Skeletal: [checkbox name="ros_msk_check" value="no back pain.|no joint pain.|no muscle aches.|no generalized muscle pain.|no neck pain.|Normal.|back pain.|joint pain.|muscle aches.|generalized muscle pain.|neck pain."][text name="ros_msk" default=" "]

-Skin: [checkbox name="ros_skin_check" value="no rash.|no bruising.|no lesions.|no itching.|Normal.|rash.|bruising.|lesions.|itching."][text name="ros_skin" default=" "]

-Neuro: [checkbox name="ros_neuro_check" value="no headache.|no dizziness.|no syncope.|no loss of consciousness.|Normal.|headache.|dizziness.|syncope.|loss of consciousness.| last seen normal"][text name="ros_neuro" default=" "]

-Psych: [checkbox name="ros_psych_check" value="denies Suicide ideation/homicide ideation.|no hallucination.|no depression.|no anxiety.|Normal.|suicide ideation\homicide ideation.|hallucinations.|depressed.|anxious."][text name="ros_psych" default=" "]

-Endocrine: [checkbox name="ros_endo_check" value="no heat/cold intolerance.|no excessive thirst.|no polyuria.|Normal.|heat intolerance.|cold intolerance.|excessive thirst.|polyuria"][text name="ros_endo" default=" "]

-Hematologic: [checkbox name="ros_heme_check" value="no excessive bruising.|no excessive bleeding.|Normal.|excessive bruising.|excessive bleeding."][text name="ros_heme" default=" "]

PHYSICAL ASSESMENT EXAM 

-BLOOD PRESSURE:[text name="pe_bp" default=" "]
-PULSE:[text name="pe_pulse" default=" "]
-RESP:[text name="Resp" default=" "]
-SPO2:[text name="pe_spo2" default=" "]
-BGL:[text name="pe_bgl" default=" "]

--General: [checkbox name="pe_general_check" value="Well developed/well nourished.|Well appearing.|in no acute distress.|malnourished.|in acute distress.|obese."][text name="pe_general" 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.|Normal.|trauma to face.|trauma to mouth."][text name="pe_heent" default=" "]

--Cardiovascular: [checkbox name="pe_cardio_check" value="Regular rate and rhythm.|no jugular vein distention.|no edema.|peripheral pulses intact.|no cyanosis.|capillary refill less than 2 seconds.|Normal.|irregular rate.|irregular rhythm.|JVD present.|edema present.|no peripheral pulses.|cyanosis present.|capillary refill greater than 2 seconds.|bleeding.|trauma.|atraumatic."][text name="pe_cardio" default=" "]

--Respiratory: [checkbox name="pe_resp_check" value="Clear to Auscultation bilaterally.|no rales, rhonchi, wheezes.|no retractions.|no accessory muscles being used.|no stridor.|Normal.|wheezing.|upper respiratory congestion.|Diminished breath sounds."][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 movement.|no pain on palpation.|strength 5/5 in all extremities.|Normal.|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.|Normal."][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.|Normal.|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.|makes a plan.|understands treatment.|thought process normal.|normal affect.|At baseline.|unpleasant.|not calm.| not cooperative.|does not make 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.|Normal.|tenderness/masses.|bruising.|bleeding."][text name="pe_heme" default=" "]

TREATMENT:
[checkbox name="treatment_1" value="No treatment or interventions made on scene by SEFD.|oxygen therapy 2L via Nasal cannula. | oxygen therapy High flow 15L via Non Rebrether.| oxygenation via BVM. |Cardiopulmonary Resuscitation. |immobilization of extremity. | immobilization due to C-spine precautions due to MOI"][textarea name="Treatment" default=" "]

TRANSPORT: [checkbox name="pe_trans_check" value="Secured to stretcher.|3 straps.|loaded for transport.|Code 3.|Code 1.|with firefighter on board.|refusal.|AMA.|released to PD EDO.|released to PD custody |no transport.|lift assist only."][text name="pe_trans" default=" "]