Background Information:
**Vitals**
BP:
Pulse:
Resp:
SPO2:
BGL:
Temp:
Weight:
Medical HX:
Meds @ Hospital:
Meds @ home:
Allergies:
Extra needed Information:
EMS interventions given (If applicable):
__________________________^^^ for PCR building^^^______________________
Transport: Sending ----> Receiving
ALS/BLS IFT/911
M14 arrived on scene to find the patient ___ y/o M/F, complaining of ___ due to _________. The
patient was in a ____ position upon M14 contact. ___**Extra needed info and describing or stated
info**___.
The patient was transferred to stretcher via _____. The patient was secured with safety belts and
stretcher railings. Patient was loaded into ambulance without incident. Treatment for the patient
consisted of taking vitals, monitoring vitals, and reassessing PT condition, __**EKG if Applicable**__.
The patient was A&O x_ w/ a GCS of __.
The patient also gave background information during transport. The patient explained that ____.
Patient was transported without incident. Patient was transferred to hospital bed via ___ without
incident. Patient was left under the observation and care of hospital staff.