Patient Care Report
Phoenix Dyanamix Emergency Educators
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Age
Sex
Dispatch Info
Primary Assessment
Level of Consciousness
Please Select
Alert
Responds to Voice
Responds to Pain
Unresponsive
Airway
Please Select
Patent
Partial Obstruction
Full Obstruction
Breathing
Please Select
Normal
Labored
Shallow
Rapid
Agonal
Absent
Circulation
Strong
Weak
Absent
Regular
Irregular
Patient Signs
Skin Condition
Normal
Dry
Moist/Clammy
Profuse Sweating
Hot
Color
Normal
Pale
Cyanotic
Flushed/Red
Pupils
Reactive L/R
Dilated L/R
Equal
Unequal
Vitals
Enter vital signs below
Rows
Time
Pulse
Blood Pressure
RR/Quality
SPO2
BGL
Pain
#1
#2
#3
#4
#5
SAMPLE History
Type a question
Rows
History Information
Signs/Symptoms
Allergies
Medications
Past History
Last Intake
Events
Patient Assessment Findings
Type a question
Rows
Patient Assessment Findings
Head
Ears/Eyes/Face
Neck
Chest
Abdomen
Back
Pelvis/GI/GU
Extremities
Neurological
Lung Sounds
Rows
Finding
Left Upper
Clear/Equal
Absent
Rales/Crackles
Rhonchi
Wheezing
Left Lower
Clear/Equal
Absent
Rales/Crackles
Rhonchi
Wheezing
Right Upper
Clear/Equal
Absent
Rales/Crackles
Rhonchi
Wheezing
Right Lower
Clear/Equal
Absent
Rales/Crackles
Rhonchi
Wheezing
Treatments, Interventions, and Response
Type a question
Rows
Treatment/Intervention
Patient Response
#1
#2
#3
#4
#5
#6
Narrative
Signature
Student Name
Submit
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