BEMS Classes ePCR
Incident
Crew / Unit
Patient
Assessment
Vitals
History
Treatment
Transport
Narrative
Review
Incident / CAD Information
Run #
*
Date
*
Dispatch Complaint
Priority
Alpha
Bravo
Charlie
Delta
Echo
Address
City
Scene Type
Residence
Street / Highway
School
Workplace
Nursing Facility
Medical Office
Public Building
Other
Call Type
Medical
Trauma
Cardiac Arrest
Transfer
Refusal
Lift Assist
Disp
Enrt
Scene
Contact
Depart
Arrive ED
TOC
Service
Crew / Unit Information
Unit Number
Student EMT
Partner
Instructor / Preceptor
Level of Service
EMR
EMT
AEMT
Paramedic
Transport Agency
Patient Information
Initials
Age
DOB
Sex
Male
Female
Unknown
Weight
Location
Chief Complaint *
Primary Assessment
AVPU
A
V
P
U
Airway
Patent
Position
Obstructed
Breathing
Adequate
Inadequate
Absent
Circulation
Adequate
Poor
Bleeding
Skin
Pupils
GCS
Pain
General Impression
Secondary Assessment
Head/Neck
Chest
Abdomen / Pelvis
Extremities
Back / Spine
Neurological
Vital Signs Trending
Time
BP
Pulse
Resp
SpO₂
EtCO₂
BGL
GCS
Pain
SAMPLE History
History of Present Illness (HPI)
Past Medical History (PMHX)
Medications
Allergies
Interventions
Oxygen
BVM
OPA / NPA
Suction
Bleeding Control
Splinting
Spinal Motion Restriction
CPR
AED
Aspirin
Oral Glucose
Naloxone
Epinephrine Auto-Injector
Patient-Assisted Medication
Wound Care
Other
Treatment Details
Patient Response to Treatment
Transport / Disposition
Disposition
Transported
Refused Care
Treated / Released
Cancelled
No Patient Found
Destination
Transport Priority
Routine
Urgent
Emergent
Position
Sitting
Semi-Fowler's
Supine
Left Lateral
Position of Comfort
Care Transferred To
Condition at Transfer
Transfer Notes
Narrative
CHART Narrative
SOAP Narrative
Review / QA
Student Signature
Instructor Initials
Validate / Submit
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