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Get Stemi Worksheet Form

STEMI ALERT Data Sheet your hospital name Date Patient Name Patient DOB Patient MR Pt pick up location DHART 1-800-650-3222 DHMC ED 603-650-7001 DHMC Cath lab 603-650-7783 DHMC CVCC 603-650-7370 DHMC Cardiology Fellow 603650-5000 page ED Provider Pt s Cardiologist if known ED Nurse Mode of Transport into ED Ambulance Service Section I -completed by ED staff Indicator Time from continuous chest pain onset to ED presentation 1st ECG done by EMS pri.

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