Emergency Medical Services Patient Report

Section 1. Patient Information

Name: [Full patient name] Date of Birth: [YYYY-MM-DD] Age: [Patient age in years] Gender: [Patient gender] Chief complaint: [Brief description of chief complaint]

Section 2. Dispatch Details

Dispatch time: [HH:mm, 24-hour format] Incident location: [Full address or location description] Dispatch or vehicle number: [EMS vehicle or dispatch identifier] Emergency service officer name: [Name of responding officer] Initial report: [Summary of initial complaint or situation reported]

Section 3. Arrival

Emergency medical dispatch performed: [Yes/No] If yes, elaborate on medical dispatch details performed: [Describe any bystander or dispatcher-assisted interventions prior to EMS arrival] Chief complaint (reported by dispatch): [Chief complaint as reported during dispatch] Initial assessment: [Brief description of patient's condition on EMS arrival, including consciousness, distress signs, and key symptoms]

Section 4. Health Status

Previous medical history: [List relevant past medical conditions] Medications: [List current medications with names] Allergies (if known): [List known allergies or state 'None'] Patient chief complaint: [Detailed description of patient's chief complaint including radiation, severity, or other characteristics] Additional notes: [Any other relevant patient-reported information or observations]

Section 5. Vital Signs

Level of Consciousness (L.O.C): [Patient's level of consciousness, e.g., Alert, Responsive to voice] Speech: [Description of speech coherence or abnormalities] Skin: [Description of skin condition, e.g., cold, clammy] Colour: [Skin color description, e.g., pale, flushed] Respiration: [Description of breathing pattern, e.g., rapid, shallow] Pulse (bpm): [Heart rate and rhythm description] Blood Pressure: [Systolic/Diastolic mmHg] Additional notes/checks: [Any other relevant observations related to vital signs]

Section 6. Physical Examination

Injury Present: [Yes/No] [If yes, describe injuries observed] Cause of injury: [insert cause if applicable] Injury Type: [insert injury type classification] (write as Burn, Blunt, Penetration, Other or Unknown)

Section 7. Substance Use

Indicators: [insert substance-related indicators observed] (describe observed indicators such as smell of alcohol, slurred speech, etc.; only include if substance use indicators have been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.) Additional notes (i.e., substance details): [insert additional substance-related notes] (write in sentence format; only include if substance-related notes have been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)

Section 8. Additional notes

Additional notes and procedures: [Describe treatments administered, medications given, and any procedures performed en route] Transport changes: [Note any changes in transport plan or destination] Signature: [Name of the physician completing the report] Date (yyyy/mm/dd): [Date of report completion]