Ce service providers to comply with Chapter DHS 110, Wis. Admin. Code as it applies to documentation of ambulance runs by completing and providing patient care information to the receiving facility when the patient is delivered to the facility. This form is not intended to become part of the patient’s medical record. INSTRUCTIONS: Print legibly. Complete all sections of this worksheet. A copy of this worksheet or the ambulance run report must be completed and left with every patient delivered .
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How to fill out the WI F-47489 online
The WI F-47489 form, also known as the EMS patient care worksheet, is essential for ambulance service providers to document patient care information effectively. This guide provides clear, step-by-step instructions for filling out this form online, ensuring compliance with Wisconsin administrative code requirements.
Follow the steps to complete the EMS patient care worksheet online.
- Click 'Get Form' button to obtain the form and open it for completion.
- Enter the service name in the designated field to identify the ambulance service provider responsible for the patient's care.
- Input the run number to log the specific ambulance run associated with this patient care information.
- Document the incident date and location to provide context for the ambulance run.
- Record the en-route time, on-scene time, and leave scene time to outline the timeline of the patient care process.
- Fill in patient details including name, date of birth (DOB), age, sex, and weight to personalize the record for the individual being treated.
- Provide the patient's address for further identification and contact purposes.
- Indicate the provider impression and time of onset to summarize the initial assessment and the timing of the patient's symptoms.
- Complete the NOI/MOI section to describe the nature of illness or mechanism of injury.
- Fill in the physician's name if applicable, and document their findings.
- Gather vital signs data, including GCS (Glasgow Coma Scale), level of consciousness (LOC), respiratory rate, pulse rate, and blood pressure.
- Assess and note skin condition, eye response, and any oxygen given as part of the patient's treatment.
- Document any allergies the patient has, as well as their medications and past medical history.
- Verify whether an EKG was transmitted and if a glucometer was used, indicating results where applicable.
- Finalize the document by verifying all information is captured accurately.
- After completing the form, make sure to save changes, download, print, or share the completed form as needed.
Complete the WI F-47489 form online to ensure accurate patient care documentation today.
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F-47489 (08/2015). STATE OF WISCONSIN. Chapter DHS 110 Wis. Admin. Code. (608) 266-1568...
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