Crossroads Narrative

UNIT: [checkbox name="UNIT" value="704.|705.|706.|"]

RESPONSE: [checkbox name="RESPONSE" value="EMERGENT|NONEMERGENT|LIGHTS/SIRENS|NO LIGHTS NO SIRENS|UPGRADED TO EMERGENT|DOWNGRADED TO NONEMERGENT"]




DISPATCH INFO: [textarea name="dispatch" default=" "]

COVID-19 QUESTIONS: Documented fever: [select name="variable_1" value="NO|YES"]
Close contact with person with confirmed or suspected COVID-19: [select name="variable_2" value="NO|YES"]
Travel to high risk COVID-19 areas per current local guidance: [select name="variable_3" value="NO|YES"]

ARRIVED: [textarea name="arrived" default=" "]

CC: [text name="CC" default=" "]

Hx:
Onset: [text name="O" size = 55 default=" "]
Provoking/Relieving Factors: [text name="P" size = 55 default=" "]
Quality/Described As: [text name="q" size = 55 default=" "]
Radiation: [text name="r" size = 55 default=" "]
Severity: [text name="s" size = 55 default=" "]
Additional Signs/Symptoms Reported: [textarea name="s" size = 55 default=" "]
Events Surrounding Condition: [textarea name="e" size = 55 default=" "]
Other PERTINENT Hx: [textarea name="hpi" default=" "]

PMHx: [textarea name="pmhx" default=" "]

ALLERGIES: [checkbox name="allergies_check" value="NKDA"][textarea name="allergies" 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=" "]

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="consciousness" size = 55 default=" "]

INITIAL ASSESSMENT:
REVIEW OF SYSTEMS:

-CONSTITUTIONAL: [checkbox name="ros_constitutional_check" value="NORMAL WITHOUT FEVER, CHILLS, WEAKNESS, OR FATIGUE|FEVER|CHILLS|WEAKNESS|UNABLE TO ASSESS"][text name="ros_constitutional" default=" "]
-HEENT: [checkbox name="ros_heent_check" value="NORMAL WITHOUT VISION CHANGES, EAR PAIN, NASAL CONGESTION, SORE THROAT, OR COUGH|UNABLE TO ASSESS"][text name="ros_heent" default=" "]
-CARDIOVASCULAR: [checkbox name="ros_cardio_check" value="NORMAL WITHOUT CHEST PAIN, PALPITATIONS, OR SWELLING OF EXTREMITIES|CHEST PAIN|PALPITATIONS|SWELLING OF EXTREMITIES|UNABLE TO ASSESS"][text name="ros_cardio" default=" "]
-RESPIRATORY: [checkbox name="ros_resp_check" value="NORMAL WITHOUT SHORTNESS OF BREATH, HEMOPTYSIS, OR DYSPNEA|SHORTNESS OF BREATH|HEMOPTYSIS|DYSPNEA|UNABLE TO ASSESS"][text name="ros_resp" default=" "]
-GI: [checkbox name="ros_gi_check" value="NORMAL WITHOUT N/V/D, CHANGE IN APPETITE, ABDOMINAL PAIN, OR HEMATEMESIS, |CHANGE IN APPETITE|ABDOMINAL PAIN|HEMATEMESIS|NAUSEA|VOMITING|DIARRHEA|UNABLE TO ASSESS"][text name="ros_gi" default=" "]
-GU: [checkbox name="ros_gu_check" value="NORMAL WITHOUT INCREASED URINARY FREQUENCY, URGENCY, DYSURIA, HEMATURIA, OR LEAKAGE OF URINE|URINARY FREQUENCY|URINARY URGENCY|DYSURIA|HEMATURIA|LEAKAGE OF URINE|UNABLE TO ASSESS"][text name="ros_gu" default=" "]
-MSK: [checkbox name="ros_msk_check" value="NORMAL WITHOUT NECK, BACK, OR JOINT PAIN, MUSCLE ACHES OR PAIN|BACK PAIN|JOINT PAIN|MUSCLE ACHES|GENERALIZED MUSCLE PAIN|NECK PAIN|UNABLE TO ASSESS"][text name="ros_msk" default=" "]
-SKIN: [checkbox name="ros_skin_check" value="NORMAL WITHOUT RASH, BRUISING, LESIONS, OR ITCHING|RASH|BRUISING|LESIONS|ITCHING|UNABLE TO ASSESS"][text name="ros_skin" default=" "]
-NEURO: [checkbox name="ros_neuro_check" value="NORMAL WITHOUT HEADACHE, DIZZINESS, SYNCOPE, OR OTHERWISE LOSS OF CONSCIOUSNESS|HEADACHE|DIZZINESS|SYNCOPE|LOSS OF CONSCIOUSNESS|UNABLE TO ASSESS"][text name="ros_neuro" default=" "]
-PSYCH: [checkbox name="ros_psych_check" value="NORMAL WITHOUT SUICIDAL/HOMICIDAL IDEATIONS, HALLUCINATIONS, DEPRESSION, OR ANXIETY|SUICIDAL/HOMICIDAL IDEATIONS|HALLUCINATIONS|DEPRESSED|ANXIOUS|UNABLE TO ASSESS"][text name="ros_psych" default=" "]
-ENDOCRINE: [checkbox name="ros_endo_check" value="NORMAL WITHOUT HEAT/COLD INTOLERANCE, EXCESSIVE THIRST, OR POLYURIA|HEAT INTOLERANCE|COLD INTOLERANCE|EXCESSIVE THIRST|POLYURIA|UNABLE TO ASSESS"][text name="ros_endo" default=" "]
-HEMATOLOGIC: [checkbox name="ros_heme_check" value="NORMAL WITHOUT EXCESSIVE BRUISING OR BLEEDING|EXCESSIVE BRUISING|EXCESSIVE BLEEDING|UNABLE TO ASSESS"][text name="ros_heme" default=" "]

PHYSICAL EXAM
Vital signs documented on page 8 in the "activity log" section of report
 
-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=" "]




TREATMENT: [checkbox name="treatment" value="PRIMARY AND SECONDARY ALS ASSESSMENT|PRIMARY AND SECONDARY BLS ASSESSMENT|CONTINUOUS CARDIAC MONITORING"] [textarea name="rxt" default=" "]

HOSPITAL ACTIVATIONS: [checkbox value="Cardiac Alert|Stroke Alert|Trauma Alert|Sepsis Alert"]

TRANSPORT: [checkbox name="pe_trans_check" value="SECURED PATIENT TO STRETCHER WITH 3 STRAPS AND RAILS UPRIGHT|LOADED INTO AMBULANCE 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 ALABAMA MEDICAL CENTER|TRANSPORTED TO DALE MEDICAL CENTER|TRANSPORTED TO MEDICAL CENTER BARBOUR"][text name="pe_trans" default=" "]

REPORT: [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"][text name="pe_rep" default=" "]

NURSE RECEIVING PATIENT: [text name="Nurse" size = 55 default=" "]

SIGNATURES: [checkbox name="SIGNATURE" value="OBTAINED FROM PATIENT|OBTAINED FROM GUARDIAN/POA|NOT OBTAINED FROM PATIENT|SIGNED BY LAW ENFORCEMENT AS GUARDIAN|UNABLE TO SIGN|NO REPRESENTATIVE AVAILABLE|NURSE SIGNED AS WITNESS"][text name="pe_SIG" default=" "]

[checkbox name="AMA" value="IN SPITE OF MULTIPLE ATTEMPTS BY MYSELF AND MY PARTNER TO CONVINCE THE PATIENT TO BE TRANSPORTED TO HOSPITAL FOR EVALUATION AND TREATMENT, WE HAVE UNFORTUNATELY BEEN UNSUCCESSFUL. HOWEVER, THE PATIENT HAS THE CAPACITY TO GIVE, RECEIVE, AND WITHHOLD INFORMATION. THE PATIENT VERBALIZES UNDERSTANDING OF THEIR CONDITION AND SYMPTOMS AND THAT REFUSING CARE COULD POSE SIGNIFICANT RISK TO THEIR LIFE. THE PATIENT HAS VERBALIZED TO ME THAT THEY UNDERSTAND OUR SPECIFIC TREATMENT PLAN WHICH INCLUDES TRANSPORT TO HOSPITAL, AND UNFORTUNATELY DOES NOT AGREE WITH US AND UNDERSTANDS WITHOUT THIS TREATMENT MAY CAUSE WORSENING OF CONDITION OR DEATH. THE PATIENT UNDERSTANDS THEY ARE FREE TO CALL 911 IF CONDITION WORSENS AND THEY FEEL THEY WISH TO BE TRANSPORTED TO EMERGENCY DEPARTMENT FOR FURTHER EVALUATION AND TREATMENT."]

[checkbox value="End of Report Paramedic JRJ 728812"]