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    EMS-SAMPLE Notes

    Uploaded by

    Japhet Ramos
    EMS

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    EMS-SAMPLE Notes

    Uploaded by

    Japhet Ramos
    4 views1 page
    EMS

    Original Title

    EMS-SAMPLE_notes

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    © © All Rights Reserved

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    EMS

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    4 views1 page

    EMS-SAMPLE Notes

    Uploaded by

    Japhet Ramos
    EMS

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    ADVENTIST YOUTH EMERGENCY MEDICAL TEAM

    EMERGENCY MEDICAL NOTES

    Incident Location: ___________________________________ Date: ______________________


    Time of Receive: ____________________________________
    Transported to: _____________________________________

    Patient Information

    Patient Name: _____________________________ Gender: Male Female Age: _____


    Patient Address: ___________________________ Birthdate: _____________________
    District: __________________________________ Church: _________________________

    Signs and Symptoms:


    _________________________________________________________________________________________
    _______________________________________________________________________________________
    Allergies:
    _________________________________________________________________________________________
    _______________________________________________________________________________________
    Medications:
    _________________________________________________________________________________________
    _______________________________________________________________________________________
    Past Medical History:
    _________________________________________________________________________________________
    _______________________________________________________________________________________
    Last Intake:
    _________________________________________________________________________________________
    _______________________________________________________________________________________
    Event / Activity: ___________________________________________________________________________
    Time: 5 min. Pulse: Respiration: BP: mmHg Pain:
    Time: 15 min. Pulse: Vital
    Respiration: Signs BP: mmHg Pain:
    Time: 30 min. Pulse: Respiration: BP: mmHg Pain:
    Lung Sounds: ______________________________________ SpO2: _________________________
    Capillary Refill Time: _________________________________
    Temperature: ______________________________________
    GCS: ______________________________________________

    Assessment

    DATA:

    ACTION:

    REACTION:

    EMT Information

    Medical Leader: ______________________________ DOC.officer: ________________________________


    Signature over Printed Name Signature over Printed Name

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