Patient Care Report
Minor First Aid does not require report
Date/Time of Patient Contact
*
-
Month
-
Day
Year
Date
Hour Minutes
Name
First Name
Last Name
Date of Birth
Phone Number
Please enter a valid phone number.
Type of Incident
Medical
Trauma
First Aid
Refusal of Care
Other
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Narrative
Heart Rate
Pulse Quality
Strong
Regular
Weak
Irregular
Absent
Resp Rate
Resp Quality
Non-Labored
Increased Effort
Shallow
Ineffective
Other
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Supplies Used
Ice Pack
Band aid/ Minor Bandaging
Major Bandaging
Airway/BVM
Other
Should be Empty: