Title Page
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Automatically Generated Document Number
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Report Title
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Recorded by
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Date created
Medical Report Form
A
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Casualty Name
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Casualty Age
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Casualty Date of Birth
T
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Time of Injury/Incident
M
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Mechanism of Injury/Onset of Illness
I
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Injuries Found/Suspected Symptoms of Illness
S - Signs
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Respiration Rate (breaths per minute)
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Pulse Rate
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SpO2 - Air
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SpO2 - on O2
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Blood Pressure - Syst
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Blood Pressure - Diast
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Pupil Diameter (mm) - left eye
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Pupil Diameter (mm) - right eye
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Blood Sugar - BM
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Blood Temperature
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Where is the casualty on the AVPU scale? Alert, Verbal, Pain, Unresponsive
T
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Treatment Given
AMPLE
A
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Allergies
M
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Normal Medications
P
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Previous Medical History
L
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Last Oral Intake
E
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Events leading to illness or injury
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Filling out Vital Signs Monitor Chart? (inside medical folder)
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Evacuation Required?
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Fill out Medical Report for Evacuation (inside medical folder)
Patient Timeline Record
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Following the initial assessment, please record daily patient treatment/progress below: (including all dates)