Get Trauma Registry Patient Abstraction Form - Healthy Arkansas

Filling out the Trauma Registry Patient Abstraction Form - Healthy Arkansas online is an essential process for capturing vital patient information. This guide provides clear, step-by-step instructions to help you successfully complete each section of the form.

Follow the steps to fill out the form accurately.

1. Click ‘Get Form’ button to access the Trauma Registry Patient Abstraction Form and open it for editing.
2. Begin by entering the demographics of the patient in Section 1. Fill out the ED arrival date, trauma band number, first and last name, middle initial, date of birth, age unit, race, ethnicity, gender, social security number (last four digits), home address, and details about the alternate home residence as needed.
3. In Section 2, provide information related to the injury. Note the injury date and time, incident state, zip code, city, and county. Include the primary and additional ICD-9 and ICD-10 codes, injury details, and determine if the injury was work-related. Record any protective devices and details about child-specific restraints if applicable.
4. For Section 3, document pre-hospital information, including the EMS agency, transport mode, level of provider, and timeline of EMS response dates. Specify the reason for choosing the destination hospital and any scene-related delays experienced.
5. In Section 4, provide details related to any inter-facility transfer and document all hospital information, including arrival and discharge dates, transfer mode, and SBP, pulse rate, and other clinical details necessary for a complete record.
6. Section 5 focuses on the emergency department information. Note where the patient arrived from, the admitting services, trauma team activation levels, and ED discharge disposition.
7. Complete Section 6 by detailing any procedures undertaken, their codes, and the OR disposition of the patient.
8. In Section 7, fill out the diagnoses, including injury narratives and anatomical diagnoses with the respective codes and severity.
9. Section 8 requires you to indicate any comorbidities and complications relevant to the patient's condition.
10. In Section 9, provide the hospital outcomes such as discharge date, total hospital days, LOS in ICU, and the hospital disposition.
11. Fill out Section 10 regarding financial information, documenting primary and secondary payment methods. Input any available financial charges and reimbursement information.
12. Once all sections are completed, ensure that all fields are correctly filled. Users can save changes, download, print, or share the form as required.

Start filling out the Trauma Registry Patient Abstraction Form online today to ensure accurate documentation.