Get Patient Care Form

The Patient Care Form is an essential document used to record vital information about patients during emergency situations. This guide will provide clear, step-by-step instructions for users to effectively complete the form online.

Follow the steps to fill out the Patient Care Form accurately.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by providing patient identification information. This includes printing the last name, first name, middle initial, address, city, state, and ZIP code in the designated fields. Ensure all information is accurate and legible.
3. Record the patient's Social Security Number (SSN), age, sex, and race in the respective fields. Please ensure you use the options provided for sex and race, selecting the appropriate choice from the available list.
4. Indicate the disposition by choosing one option from the provided list, which includes options such as 'hospital ER,' 'patient refused treatment,' or 'nursing home.'
5. Document the type of incident and incident location by filling in the appropriate sections. Mark the relevant options for the primary impression and preliminary impressions, ensuring no more than four are selected.
6. Outline the treatment procedures that were administered to the patient using the specified codes. Mark each procedure performed clearly and accurately in the respective boxes.
7. Complete the section for advanced procedures, if applicable, by documenting any significant interventions that were undertaken during the patient care.
8. Fill in the vital signs section, including pulse rate, blood pressure, and respiratory rate. Provide notes for the Glasgow Coma Scale if required.
9. Finally, make sure to sign and certify the document with your name and certification number in the corresponding section. Once complete, you can save your changes, download the form for your records, print it, or share it as needed.

Start filling out the Patient Care Form online today.