Get Patient Care Documentation

Filling out the Patient Care Documentation is a critical part of providing quality emergency medical services. This guide outlines the necessary steps to ensure that the form is completed accurately and efficiently, facilitating better patient care and compliance with regulations.

Follow the steps to successfully complete the Patient Care Documentation.

1. Click the 'Get Form' button to access the Patient Care Documentation form and open it for editing.
2. Begin by entering the unit number for the response in the designated field, which helps track the specific EMS unit involved.
3. Input the incident date and time accurately to maintain a proper record of the event.
4. Log the call receipt time and dispatch time, which are important for tracking response times.
5. Document the arrival at the scene time to provide a clear timeline of the response.
6. Fill in the incident location where the EMS response took place.
7. Provide the patient's information: name, age and date of birth, gender, weight, address, and chief complaint.
8. Record vital signs and any appropriate physical assessments to thoroughly convey the patient's condition.
9. Detail the emergency care rendered and the patient's response to such treatment, ensuring accuracy and completeness.
10. Document the patient disposition, including details on where they were transported.
11. Enter the scene departure time and the arrival time at the receiving hospital.
12. Provide the name of the receiving facility to ensure proper communication.
13. List names of the EMS personnel involved in the call along with their identifier numbers.
14. If possible, obtain and input signatures from persons completing the PCR to verify authenticity.
15. Complete the form as soon as possible after the response to maintain a high standard of care.
16. If unable to fully complete the form before leaving the facility, leave a DRAFT version with clear markings.
17. Ensure that completed PCRs are sent to the receiving facility promptly, as delays can compromise patient care.
18. Make no alterations to the PCR unless you are the individual who completed the form, maintaining the integrity of the record.

Start filling out your Patient Care Documentation online today for seamless patient care.