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__________________________________ Age _______ Gender __________ Incident Date ______________________ MOI / Chief Complaint _________________________________________________________________________________________________ Incident Time ______________________ LOC VITALS Alert Verbal Painful Unresponsive TIME GCS Blood Pressure Eye Opening Pulse Rate Spontaneous To Speech To Pain None Respirations 4 3 2 1 Best Verbal Response Pulse Ox Oriented Disoriented Monosyllabic Incomprehensib.
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