I.C.H.A.r.T.

Ix: <<<COMPANY>> BLS UNIT <<<#>> ARRIVED TO <<<HOSPITAL>> FOR A SCHEDULED TRANSFER OF <<<AGE>>> y.o. <<<GENDER>>>. PATIENT WAS FOUND <<<SEMI-FOWLER’S>> IN A HOSPITAL BED WITH NO IMMEDIATE LIFE THREATS. MRN#<<<>>>.

C/C: <<<CHIEF COMPLAIN>>>

Hx: PATIENT PRESENTED TO <<<HOSPITAL>> ON <<<DATE>> VIA <<AMBULANCE?>> BECAUSE OF <<WHY?>>. PATIENT RECEIVED <<TEST>> AND <<<TREATMENT>>. PATIENT MEDICAL HISTORY INCLUDES: <<<>> (SEE CHART). PATIENT MEDICATIONS INCLUDE: <<<>>> (SEE CHART). PATIENT HAS <<<NKDA>>>. PATIENT CLEARED BY SENDING HOSPITAL FOR TRANSFER.

Ax: PATIENT A/O x <<<>>>. GCS <<<>>>. ABC INTACT. EXTREMITY WEAKNESS x <<<>>>. SKIN PINK, WARM AND DRY. BREATHING FULL AND EFFECTIVE WITH BILATERAL MOVEMENT. PATIENT DENIES ANY NVD, SOB, AND CP. PATIENT CLAIMS <<<<>>>. VITALS ARE WITHIN PATIENT’S NORMAL PARAMETERS (STABLE, SEE CHART).

Rx: PATIENT SHEETED FROM HOSPITAL BED TO GURNEY ASPT BY EMT x<<<>>> GURNEY SECURED BY RAILS x2, BELTS x4. PATIENT PLACED IN POC. VITALS MONITORED ON SCENE (STABLE, SEE CHART).

Tx: PATIENT WAS TRANSPORTED TO <<<<>>> FOR CONTINUATION OF CARE AND MONITORING. BLS REQUIRED FOR TRANSPORT DUE TO <<<PATIENT BEING UNABLE TO SAFELY SIT UPRIGHT ON OWN>>>. PATIENT WAS SHEETED TO FACILITY BED ASPT BY EMT x<<<>>. BED SECURED BY RAILS x2 AND LOWERED TO THE GROUND. BELONGINGS WERE LEFT AT PATIENT BEDSIDE. CARE WAS TURNED OVER TO <<<<>>> WITHOUT INCIDENT. <<<>>> AT PATIENT BEDSIDE UPON DEPARTURE. <<<<INITIALS / EMT- EMPLOYEE ID>>>