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Fill Out Your Prehospital Care Report Form

The Prehospital Care Report (PCR) form is a crucial document used by EMS providers to record patient information during emergency medical services. This form captures vital data about the incident, patient condition, treatments provided, and outcomes. Accurate completion of the PCR is essential for effective patient care and proper documentation in the event of legal scrutiny.

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Article Structure

The Prehospital Care Report (PCR) form is a crucial document utilized by Emergency Medical Services (EMS) to capture essential data during emergency medical responses. This comprehensive form includes fields for key information like the incident date, report number, vehicle identification, and details about the EMS agency involved. The form helps track the disposition of the patient, whether they were treated and transported, refused care, or were pronounced dead at the scene. It collects critical incident details such as the location, response modes, and run times for better situational awareness. Furthermore, it documents patient demographics, medical history, and vital signs during the response, ensuring continuity of care once the patient reaches a medical facility. Additional sections address medications administered, procedures performed, and the crew members involved, fostering excellent accountability and organization within healthcare teams. By systematically gathering this information, the PCR form plays a vital role in maintaining high-quality emergency medical services and is instrumental for subsequent analysis and quality assurance in the field.

Prehospital Care Report Example

Prehospital Care Report

1.INCIDENT DATE

2.OKLAHOMA REPORT NUMBER

3.EMS AGCY #

4.VEHICLE NUMBER

5.EMS UNIT CALL SIGN

6.STATION #

7.INCIDENT/PATIENT DISPOSITION

Treated, Transport EMS

No Treatment Required

No Patient Found Pt Refused Care

Treated, Transferred Care Treated & Released

Treated, Transported Law Enforcement Treated, Transported Private Vehicle

Canceled Dead at Scene

8. INCIDENT ADDRESS

9. INCIDENT CITY

10. INCIDENT ST 11. INCIDENT ZIP

12. INCIDENT COUNTY

13. RESPONSE MODE TO SCENE 14. FROM SCENE

Run Times

19.

Unit Arrived at Scene:

Lights/Sirens

Use Military Time

20.

Arrived at Patient:

No Lights/No Sirens

15.

Estimated Time of Onset:

21.

Unit Left Scene:

Initial Lights/Sirens Downgraded to no Lights/Sirens

16. PSAP / Initial Call for Help:

22. Patient Arrived at Destination:

Unit Notified by Dispatch:

Unit Back in Service:

Initial No Lights/Sirens Upgraded to Lights/Sirens

17.

23.

18.

Unit Enroute:

24.

Unit Back at Home Location:

25. TYPE OF SERVICE REQUESTED

26. INCIDENT LOCATION TYPE

N/A

27. CONDITION CODE(S) SEE REFERENCE SHEET

911 Response

Medical Transport

Home/residence

Farm

Mine/quarry

Industrial place

Interfacility Transfer

Intercept

Sport/recreation place

Street/highway

Public building

Trade/service

Mutual Aid

Standby

Health care facility

Residential institution

Lake/river

Other

28. COMPLAINT REPORTED BY DISPATCH

29. EMERGENCY MEDICAL DISPATCH PERFORMED

30. CMS LEVEL OF SERVICE

(select one) SEE REFERENCE SHEET

Yes, with pre-arrival instructions

BLS, Emergency

BLS

Yes, without pre-arrival instructions

Unknown

N/A

ALS, Level 1 Emergency

ALS Lev 1

31. NUMBER OF PATIENTS AT SCENE

32. MASS CASUALTY

33. PRIMARY ROLE OF THE UNIT

ALS, Level 2

Helicopter

Transport

Supervisor

Paramedic Intercept

Airplane

Single

None

Multiple

N/A

Specialty Care

Not Applicable

Yes

N/A

Non-transport

Rescue

ODOMETER READINGS

38. DEST ZIP

39. ORIG FAC ID

40. REC FAC ID

41. LATITUDE

LONGITUDE

34. Begin

35. Arrive

36. Destination

37. End

42. PATIENT LAST NAME

43. PATIENT FIRST NAME

44. M I

45. PATIENT ADDRESS

46. SAME AS INCIDENT ADDRESS

47. PATIENT CITY

48. STATE

49. PATIENT ZIP CODE

50. COUNTY

51. PT TELEPHONE NUMBER

52. RACE (single-choice)

53. ETHNICITY

Area Code

Telephone Number

American Indian/Alaska Nat

Hispanic

African American/Black

Not Hispanic

Asian

55. AGE

56. AGE UNITS

57. DATE OF BIRTH

58. SOCIAL SECURITY NUMBER

Native Hawaiian/Pac Islander

54. GENDER

Hours

Days

White

Female

Months

Years

Other

Male

59.PRIMARY PAYMENT METHOD

Not Billed	Unknown
Self Pay	Not Available

Workers Comp

Insurance

Medicare

Medicaid

Other Government

Not Applicable

Medicare #: _______________	Insurance1 #: _____________
Medicaid #: _______________	Insurance2 #: _____________

60.CHIEF COMPLAINT

61.PATIENT MEDICAL HISTORY

62.PATIENT MEDICATION HISTORY

63.PATIENT MEDICATION ALLERGIES

64.NARRATIVE:

Receiving Facility: _________________I received a verbal & written report on the care of this patient: __________________________________________________

INITIAL & FINAL VITAL SIGNS

Not Applicable

GLASGOW COMASCALE

Not Applicable

65.

66.

67.

68.

69.

70.

71.

72.

73.

74.

75.

76.

77.

78.

79.

Time

Pulse

Resp

SBP

DBP

Method BP

LOC

O2 Sat

EKG

Skin

Pupils

Eyes

Verbal

Motor

GCS Score

Arterial Line

Warm

Pale

Left

Right

4 Spon

5 Oriented

6 Obeys

Auto Cuff

Cool

Pink

Normal

3 Speech

4 Confused

5 Localizes

Manual Cuff

Dry

Constricted

2 Pain

3 Inapprop

4 W/draws

Palpate Cuff

SEE

Moist

Dilated

1 None

2 Garbled

3 Flexion

Venous Line

REFERENCE

Cyanotic

Non-Reactive

1 None

2 Extent

SHEET

Diaphoretic

1 None

Arterial Line

Warm

Pale

Left

Right

4 Spon

5 Oriented

6 Obeys

Auto Cuff

Cool

Pink

Normal

3 Speech

4 Confused

5 Localizes

Manual Cuff

SEE

Dry

Constricted

2 Pain

3 Inapprop

4 W/draws

Palpate Cuff

Moist

Dilated

1 None

2 Garbled

3 Flexion

REFERENCE

Venous Line

Cyanotic

Non-Reactive

1 None

2 Extent

SHEET

Diaphoretic

1 None

MEDICATIONS

None

Not applicable

80.Time

81. Medication Given SEE REFERENCE SHEET

82. Meds Administered By:

83. Med Complications SEE REFERENCE SHEET

84. Medication Authorization

CM 1

CM 2

CM 3

Protocol (Standing Order)

On-Line

Written Orders (Patient Specific)

On-Scene

Not Applicable

CM 1

CM 2

CM 3

Protocol (Standing Order)

On-Line

Written Orders (Patient Specific)

On-Scene

Not Applicable

CM 1

CM 2

CM 3

Protocol (Standing Order)

On-Line

Written Orders (Patient Specific)

On-Scene

Not Applicable

PROCEDURES

None

Not applicable

85. Time

86. Procedure

SEE RREFERENCE SHEET

87. # Attempts

88. Successful

89. Done By:

90. Procedure Complications SEE REFERENCE SHEET

YES

CM 1

CM 2

CM 3

YES

CM 1

CM 2

CM 3

YES

CM 1

CM 2

CM 3

I have been given notice of HIPAA Privacy Practices.

This is to certify that I am refusing treatment/transport. I have been informed of the risk(s) involved, and thereby release the ambulance service, its attendants, and its affiliates from responsibility that may result from this action.

Patient Authorization & Release: I, the undersigned, hereby authorize __________________________________ (“Provider”) to provide me with emergency or non-emergency

transportation and/or any medical treatment or services it deems necessary. I acknowledge that I am responsible for paying for all charges based on Providers current billing rates, regardless of whether or not I personally requested emergency medical services (EMS) originally. I hereby assign to Provider all my insurance and third party agency benefits for EMS and authorize such benefits to be paid to Provider. I authorize the release of any medical, hospital, or other records or information about me, or my dependents to my insurance carriers in order to determine insurance or other third party benefits for EMS to which my dependents or I may be entitled.

__________________________________________		_______________________________________________________________________
Witness	Date / Time	Patient / Guardian	Date / Time

Prehospital Care Report Number:

SYMPTOMS 91. P=PRIMARY (pick one)		Not applicable
	92. A =ASSOCIATED (multi)	Not applicable
P A	P A
	Transport Only	Fever
	None	Malaise
	Bleeding	Mass/Lesion
	Breathing	Mental/Psych
	Changes in Responsiveness	Nausea/Vomiting
	Choking	Pain
	Death	Palpitations
	Device/Equip Problem	Rash/Itching
	Diarrhea	Swelling
	Drainage/Discharge	Weakness
		Wound

PROVIDER IMPRESSION

93. P= PRIMARY (pick one)

P SP S

Abdominal pain

Airway obstruct

Allergic reaction

Altered LOC

Behavior/psych

Cardiac arrest

Cardiac arrhythmia

Chest pain

CHF COPD

Not applicable	94. S=SECONDARY (pick one)		Not applicable
P	S

Diabetic	Respiratory arrest	95. ALCOHOL/DRUG USE
Electrocution	Respiratory distress	INDICATORS (multi-choice)
Hyperthermia	Seizure		Not applicable
Hypothermia	Sexual assault/rape
			None
Hypovolemia/shock	Stings/venomous bites
			Smell of alcohol present
Inhalation injury/toxic gas	Stroke/CVA
			Pt admits to alcohol use
Inhalation/smoke	Syncope/fainting
			Pt admits to drug use
Obvious Death	Traumatic injury
			Alcohol and/or drug
Poisoning/drug OD	Vaginal hemorrhage
		paraphernalia at scene
Pregnancy/OB delivery

96. CHIEF COMPLAINT ANATOMIC LOCATION

Not applicable

97. CHIEF COMPLAINT ORGAN SYSTEM

98. Incident Work-Related

Abdomen

Extremity Lower

Genitalia

Not applicable

Endocrine/Metabolic

Musculoskeletal

Pulmonary

Yes

Back

Extremity Upper

Head

Cardiovascular

OB/GYN

Renal

Unknown

Chest

General/Global

Neck

CNS/Neuro

Global

Psych

Skin

Not applicable

99. CARDIAC ARREST

100. RESUSCITATION (multi)

101. TIME OF ARREST (mins)

102. ARREST

103. CAUSE OF ARREST

Not applicable

WITNESSED BY:

Not applicable

Drowning

Not applicable

0-2

2-4

Not applicable

Unknown

Respiratory

Yes, Prior to Arrival

Defibrillation

None-DOA

4-6

6-8

Lay Person

Presumed Cardiac

Electrocution

Yes, After Arrival

Ventilation

None-DNR/DNAR

8-10

10-15

Healthcare Provider

Trauma

Other

Chest Comp

None-Signs of life

15-20

>20

Not Witnessed

STEMI

Not applicable

108. Stroke Scale

104. 12-Lead EKG used:

Yes

Not applicable

Not available

Not known

105.

Transmitted for interpretation:

Yes

Cincinnati Stroke Scale Negative

LA Stroke Scale Negative

106.

Interpreter (indicate all):

Paramedic

Physician

Computer Program

Cincinnati Stroke Scale Non-conclusive

LA Stroke Scale Non-conclusive

107.

STEMI probable:

Yes

Inconclusive

Cincinnati Stroke Scale Positive

LA Stroke Scale Positive

PRIOR AID RECEIVED PRIOR TO ARRIVAL OF UNIT See Reference Sheet

111. OUTCOME OF PRIOR AID

109. PRIOR AID PERFORMED BY:

110. PRIOR AID (Use PROCEDURES

Improved

Unchanged

Worse

Unknown

List and/or MEDICATIONS List)

EMS Provider

Other Health Care Provider

112. BARRIERS TO EFFECTIVE CARE [multi-choice]

Law Enforcement

Lay Person

Unknown

Not applicable

Physically Impaired

EMS Provider

Other Health Care Provider

Developmentally Impaired

Physically Restrained

Law Enforcement

Lay Person

Unknown

Unattended/Unsupervised

Speech Impaired

EMS Provider

Other Health Care Provider

Hearing Impaired

Unconscious

Law Enforcement

Lay Person

Unknown

Language

None

EMS Provider

Other Health Care Provider

Unattended or unsupervised (including minors)

Law Enforcement

Lay Person

Unknown

113. TRAUMA

114. CAUSE

115. MECHANISM OF

116. HOSPITAL TEAM NOTIFIED

117. TIME HOSPITAL

118. Trauma Triage Level

PRESENT

OF INJURY

INJURY

TEAM NOTIFIED

Not applicable

Priority 2

Not applicable

Trauma

Yes

Stroke

Priority 1

Priority 3

Blunt

Penetrating

STEMI

Burn

Not Known

_______________

________________

See Ref. Sheet

119. TRAUMA TRIAGE CRITERIA

Intercept:

124. TRAUMA REFERRAL

CENTER (TreC)

Not applicable

Flail chest

120.TIME REQUESTED:

121.TIME ARRIVED:

NOTIFIED

GCS <=13

Two or more proximal long bone fractures

GCS improving

Yes

N/A

Open or depressed skull fracture

Resp compromise resulting from trauma

Unstable pelvis

125.TreC

126. TIME

Hemodynamic compromise from trauma

PTS <= 8

Blunt trauma/no hemodynamic trauma

TRACKING#:

TReC

BSA >= 10%

Penetrating injury to trunk-neck-head

122.TIME OF CARE TRANSFER:

123.REC AGENCY:

N/A

NOTIFIED:

BSA < 10%

Penetrating injuries to extremities

N/A

Other single system injury

Amputation proximal to wrist or ankle

Minor injuries

Paralysis resulting from trauma

127. VEHICULAR INJURY INDICATORS

Not applicable

128. USE OF SAFETY EQUIPMENT [multi]

Not applicable

None

Dash Deformity

Fire

Space Intrusion >1 foot

Child Restraint

Lap Belt

Protective Gear

DOA Same Vehicle

Rollover/Roof Deformity

Windshield Spider/Star

Eye Protection

Pers Flotation Device

Shoulder Belt

Ejection

Side Post Deformity

Steering Wheel Deformity

Helmet Worn

Protective Clothing

Other (Airbag)

129. AIRBAG DEPLOYMENT

Not applicable

130. PATIENT POSITION

Not applicable

Unknown

Airbag Deployed Front

Airbag Deployed Other

No Airbag Present

Driver

Left (non-driver)

Middle

Right

Other

Airbag Deployed Side

Airbag Not Deployed

Unknown

131. TYPE OF DESTINATION

132. REASON FOR CHOOSING DESTINATION

133. ED DISPOSITION

134. HOSPITAL DISPOSITION

Home

Hospital

Closest

On-line Med Control

Admit-floor

Death

Admit-ICU

Discharge

Not applicable

Medical Office/Clinic

Morgue

Diversion

Other

Death

Transfer-other hosp

Nursing Home

Other EMS (air)

Family Choice

Pt Choice

Not Applicable

Transfer-nursing home

Other EMS (ground)

Police/Jail

Insurance

Pt Physician’s Choice

Released

Transfer-other

Other

Not applicable

Law Enforcement Choice

Protocol

Transferred

Transfer-rehab

Specialty Resource Center

Not applicable

Unknown

135. TYPE OF DELAY(S)

136. TYPE OF DELAY(S)

137. TYPE OF DELAY(S)

138. TYPE OF DELAY(S)

139. TYPE OF DELAY(S) (select all)

(select all)

SCENE (select all)

TRANSPORT (select all)

RETURN

DISPATCHER

RESPONSE

Not applicable

None

Crowd

Clean up

Caller Uncooperative

Crowd

Directions

Decontamination

High Call Volume

Directions

Distance

Documentation

Language Barrier

Distance

Diversion

ED Overcrowding

Location (Inability to obtain)

Diversion

Extrication>20 Min

HazMat

Equipment Failure

No Unit Available

HazMat

Safety Conditions

Equipment Replenishment

Safety Conditions

Language Barrier

Staff Delay

Technical Failure

Staff Delay

Safety Conditions

Traffic

Vehicle Failure

Other

Traffic

Staff Delay

Vehicle Crash

Other

Vehicle Crash

Traffic

Vehicle Failure

Vehicle Crash

Weather

Vehicle Failure

Other

Weather

Other

Enter CREW MEMBER Information for:

140. CREW MEMBER ID NUMBER

141. LEVEL OF SERVICE

142. CREW MEMBER ROLE

CREW MEMBER 1 ID NUMBER

CREW MEMBER 2 ID NUMBER

CREW MEMBER 3 ID NUMBER

____________________________________________________________

Crew Member1 Signature

Crew Member2 Signature

Crew Member3 Signature

Ο B

Ο I Ο P Ο EMR

Ο Physician

Ο Nurse Ο Student Ο Other

Ο B Ο I

Ο P

Ο EMR

Ο Physician Ο Nurse Ο Student Ο Other

Ο B Ο I Ο P

Ο EMR

Ο Physician

Ο Nurse Ο Student Ο Other

CREW MEMBER 1 ROLE

CREW MEMBER 2 ROLE

CREW MEMBER 3 ROLE

Primary Patient Caregiver

Driver

Primary Patient Caregiver

Driver

Primary Patient Caregiver

Driver

Secondary Patient Caregiver

Other

Secondary Patient Caregiver

Other

Secondary Patient Caregiver

Other

Third Patient Caregiver

Prehospital Care Report

SUPPLEMENTAL PAGE

Oklahoma Report Number from 1st page:

PATIENT LAST NAME from 1st page:

INCIDENT DATE from 1st page:

Additional PATIENT MEDICAL HISTORY from 1st page:

Additional PATIENT MEDICATION HISTORY from 1st page:

Additional PATIENT ALLERGIES from 1st page:

Additional NARRATIVE from 1st page:

Report Given to: _____________________________________; Narrative page ___ of ___ pages

Necessity For Service				Patient moved to	Was patient	Did patient require	Patient placed in
Upon arrival, Patient	Was stretcher necessary?			Stretcher via	Incontinent	IV	Ambulating
Found in:	Unable to sit upright		MI	Total lift	Combative	Saline hep lock	Geri Cardiac Chair
Ambulating	Unable to balance in sitting position		Unset or poss fracture	Draw sheet	Confused/lethargic	Drug therapy	Recliner
Geri Cardiac Chair	Unconscious/shock		Acute stroke	Other _________	Dizzy	Oxygen	Wheelchair
Recliner	Req. physical restraints		MVC	Did patient	Weak	Intubation	Bed
Wheelchair	Severe hemorrhage		Other _________	Vomit	Other _______	Ventilator	Gurn/exam table
Bed	Bed Confined			Complain of nausea		EKG monitor	Other _____
Gurney/exam table	Fetal position	Contractures	Paralyzed	Complain of pain		Chemstrip
Floor						Other ______
Other _________

Additional VITAL SIGNS & Glasgow Coma Scale from 1st page:

Glasgow Coma Scale

Pediatric Trauma Score:

Age 12 and under

GCS

Time Pulse

Resp

SBP DBP

Method BP

LOC

Sat

EKG

Eyes

Verbal

Motor

Score

Weight

Airway

CNS

Wounds

Skeletal 143. PT Score

Arterial Line

4 Spon

5 Oriented

6 Obeys

Initial:

Auto Cuff

3 Speech

4 Confuse

5 Localizes

>20:+2

Normal:+2

Awake:+2

>90:+2

None: +2

None:+2

Manual Cuff

2 Pain

3 Inapprop

4 W/draws

10-20: 1

Maint:+1

Obtund:+1

90-50: 1

Minor: 1

Closed fx:+1

_____

Palpate Cuff

See Ref

1 None

2 Garbled

3 Flexion

<10:-1

Unmaint:-1

Coma:-1

<50:-1

Major:-1

Open:-1

Venous Line

Sheet

1 None

2 Extent

1 None

6 Obeys

Final:

Arterial Line

4 Spon

5 Oriented

5 Localizes

Auto Cuff

3 Speech

4 Confuse

4 W/draws

>20:+2

Normal:+2

Awake:+2

>90:+2

None: +2

None:+2

Manual Cuff

2 Pain

3 Inapprop

3 Flexion

10-20: 1

Maint:+1

Obtund:+1

90-50: 1

Minor: 1

Closed fx:+1

Palpate Cuff

See Ref

1 None

2 Garbled

2 Extent

<10:-1

Unmaint:-1

Coma:-1

<50:-1

Major:-1

Open:-1

Venous Line

Sheet

1 None

6 Obeys

>20:+2

Normal:+2

Awake:+2

>90:+2

None: +2

None:+2

Arterial Line

4 Spon

5 Oriented

5 Localizes

10-20: 1

Maint:+1

Obtund:+1

90-50: 1

Minor: 1

Closed fx:+1

Auto Cuff

3 Speech

4 Confuse

4 W/draws

<10:-1

Unmaint:-1

Coma:-1

<50:-1

Major:-1

Open:-1

Manual Cuff

2 Pain

3 Inapprop

3 Flexion

Palpate Cuff

See Ref

1 None

2 Garbled

2 Extent

Venous Line

Sheet

1 None

6 Obeys

>20:+2

Normal:+2

Awake:+2

>90:+2

None: +2

None:+2

Arterial Line

4 Spon

5 Oriented

5 Localizes

10-20: 1

Maint:+1

Obtund:+1

90-50: 1

Minor: 1

Closed fx:+1

Final:

Auto Cuff

3 Speech

4 Confuse

4 W/draws

<10:-1

Unmaint:-1

Coma:-1

<50:-1

Major:-1

Open:-1

Manual Cuff

2 Pain

3 Inapprop

3 Flexion

Palpate Cuff

See Ref

1 None

2 Garbled

2 Extent

_____

Venous Line

Sheet

1 None

MEDICATIONS

Continued from 1st page

Time

Medication Given See Reference Sheet

Medication Administered By:

Reactions

See Reference Sheet

Medication Authorization

Protocol (Standing Order)

On-Line

CM 1

CM 2

CM 3

Written Orders (Patient Specific)

On-Scene

Not applic

Protocol (Standing Order)

On-Line

CM 1

CM 2

CM 3

Written Orders (Patient Specific)

On-Scene

Not applic

Protocol (Standing Order)

On-Line

CM 1

CM 2

CM 3

Written Orders (Patient Specific)

On-Scene

Not applic

Protocol (Standing Order)

On-Line

CM 1

CM 2

CM 3

Written Orders (Patient Specific)

On-Scene

Not applic

Protocol (Standing Order)

On-Line

CM 1

CM 2

CM 3

Written Orders (Patient Specific)

On-Scene

Not applic

PROCEDURES Continued from 1st page

Time

Procedure

# Attempts

Successful

Done By:

Complications

See Reference. Sheet

YES

CM 1

CM 2

CM3

YES

CM 1

CM 2

CM3

YES

CM 1

CM 2

CM3

YES

CM 1

CM 2

CM3

YES

CM 1

CM 2

CM3

CREW MEMBER 4 ID NUMBER

CREW MEMBER 5 ID NUMBER

CREW MEMBER 6 ID NUMBER

_____________________________________________

____________________________________________

_____________________________________________

Crew Member4 Signature

Crew Member5 Signature

Crew Member6 Signature

Ο B Ο I Ο P

Ο EMR Ο Physician Ο Nurse O Student O Other

Ο B

Ο I Ο P Ο EMR Ο Physician Ο Nurse O Student O Other

Ο B

Ο I

Ο P Ο EMR Ο Physician Ο Nurse O Student O Other

CREW MEMBER 4 ROLE

CREW MEMBER 5 ROLE

CREW MEMBER 6 ROLE

Primary Patient Caregiver

Driver

Primary Patient Caregiver

Driver

Primary Patient Caregiver

Driver

Secondary Patient Caregiver

Other

Secondary Patient Caregiver

Other

Secondary Patient Caregiver

Other

Third Patient Caregiver

Get Prehospital Care Report PDF Form

Form Characteristics

Fact Name	Description
Incident Date	The report begins with the incident date, crucial for documentation and legal purposes.
Oklahoma Report Number	This unique identifier helps in tracking and reference, governed by Oklahoma's EMS regulations.
EMS Agency Number	This is a mandatory field that identifies the emergency medical services unit responding to the incident.
Patient Disposition	Multiple options, such as “Treated and Transported” or “Patient Refused Care,” provide clarity on the outcome of the response.
Response Mode to Scene	Captures the urgency of the EMS response, influencing regulatory compliance under Oklahoma law.
Patient Medical History	This section collects vital information about known medical conditions, which is essential for effective care.
HIPAA Compliance	The form contains a notice regarding HIPAA Privacy Practices, ensuring patient confidentiality during treatment.

Guidelines on Utilizing Prehospital Care Report

Filling out the Prehospital Care Report form accurately is crucial for proper documentation and continuity of care. Below are the steps required to complete this form efficiently.

Incident Date: Enter the date of the incident.
Oklahoma Report Number: Write the assigned report number.
EMS Agency Number: Fill in the emergency medical services agency number.
Vehicle Number: State the vehicle number involved in the call.
EMS Unit Call Sign: Indicate the call sign for the EMS unit.
Station Number: Enter the relevant station number.
Incident/Patient Disposition: Select the appropriate patient outcome from the provided options.
Incident Address: Fill in the specific location of the incident.
Incident City: Enter the city where the incident took place.
Incident State: Indicate the state of the incident.
Incident Zip Code: Provide the zip code for the incident location.
Incident County: Specify the county of the incident.
Response Mode to Scene: Choose the response mode utilized.
Estimated Time of Onset: Document the estimated time when the incident began.
PSAP / Initial Call for Help: Include details of the Public Safety Answering Point call.
Unit Arrived at Scene: Note the time using military format when the unit arrived at the scene.
Arrived at Patient: Record the time the unit arrived at the patient with indication of lights/sirens used.
Unit Left Scene: Indicate the time the unit departed the scene.
Patient Arrived at Destination: Document the arrival time at the receiving facility.
Unit Back in Service: Write the time the unit was available for the next call.
Type of Service Requested: State the type of service provided.
Incident Location Type: Select the applicable location type for the incident.
Number of Patients at Scene: Specify how many patients were at the scene.
Primary Role of the Unit: Indicate the main function of the unit during the incident.
Patient Information: Fill in last name, first name, middle initial, address, and contact details.
Patient Age: Specify the patient's age in appropriate units (e.g., years, months).
Date of Birth: Enter the date of birth of the patient.
Social Security Number: Provide the patient's Social Security number if applicable.
Race and Ethnicity: Select the patient's race and indicate their ethnicity.
Gender: Indicate the patient's gender.
Primary Payment Method: Choose the payment method that applies.
Chief Complaint: Describe the primary complaint of the patient.
Patient Medical and Medication History: Enter the medical and medication details for the patient.
Patient Medication Allergies: List any known allergies the patient has related to medication.
Narrative: Provide a detailed narrative about the patient’s condition and treatment received.
Vital Signs: Record the initial and final vital signs as well as the Glasgow Coma Scale score.
Medications Given: Include details on medications administered to the patient.
Procedures: State any procedures performed and their outcomes.
Crew Member Details: Document the information of all crew members involved in the response.
Barriers to Effective Care: Note any barriers experienced during the care of the patient.
Outcome of Care: Indicate how the patient was transferred and what the final disposition was.

What You Should Know About This Form

What is the purpose of the Prehospital Care Report (PCR)?

The Prehospital Care Report serves as a crucial document that records the details of prehospital care provided to patients by emergency medical services. This report includes essential information such as the date of the incident, patient demographics, assessment findings, interventions performed, and disposition of the patient after treatment. By documenting these facts, the PCR helps ensure continuity of care and provides valuable data for future medical assessments and quality improvement initiatives.

What information is collected in the PCR?

The PCR collects a wide range of information including, but not limited to, the incident date, Oklahoma report number, EMS agency details, vehicle number, patient demographics, nature of the incident, chief complaint, medical history, and assessment findings. It also documents vital signs, medications administered, procedures performed, and the final disposition of the patient, such as whether they were treated and transported or refused care. This comprehensive approach facilitates thorough patient care and accurate record-keeping.

Who is responsible for completing the PCR?

Typically, the PCR is completed by the emergency medical personnel on the scene, such as paramedics and emergency medical technicians (EMTs). Each crew member involved in patient care contributes to the report based on their role and the care provided. It is important that the information captured is accurate and complete to reflect the interventions made and patient outcomes.

How does the PCR impact patient care?

The PCR directly impacts patient care by providing a clear account of the treatment administered and the patient's condition upon arrival at the hospital. Emergency departments rely on this report to understand the patient's medical background and the prehospital care they received. Accurate and detailed documentation can lead to better treatment decisions and improved health outcomes for patients.

What happens if the patient refuses care?

If a patient refuses care, this must be clearly documented in the PCR. The report will note that the patient was informed of the risks associated with their decision to refuse treatment. It is also essential to have the patient or their guardian sign a release form to acknowledge their decision. This documentation can protect both the healthcare provider and the patient by ensuring that informed consent was considered.

Are there specific codes used in the PCR, and what do they signify?

Yes, the PCR includes specific codes, often referenced in a supplementary sheet, which signify various elements such as the condition codes, type of service requested, and complaint categories. These codes allow for standardization in reporting and facilitate accurate data collection and analysis. Accurate coding helps in efficiently communicating the nature of the incident and the care provided.

Can medical information be shared without consent?

Under HIPAA (Health Insurance Portability and Accountability Act) regulations, medical information can generally only be shared with consent. However, there are exceptions for emergency situations where patient care is necessary. The PCR includes a section in which patients typically provide their authorization for information release, which allows providers to share critical information with other medical facilities and insurance companies.

What is the significance of the response mode to the scene?

The response mode indicates the urgency with which the EMS unit responded to the scene. It could be categorized as lights and sirens or no lights and no sirens. This aspect of the report is vital for understanding how quickly care was initiated based on the perceived severity of the incident. Documenting the response mode helps in evaluating the effectiveness of emergency response protocols.

How does the PCR support legal and administrative processes?

The PCR serves as a legal document that can be used in investigations or proceedings regarding the care that the patient received. Accurate and thorough documentation helps protect EMS providers against liability and ensures transparency in patient care processes. Administratively, analysis of PCR data can contribute to improving emergency services and healthcare protocols.

Is training required for those completing the PCR?

Yes, training is required for personnel completing the PCR. EMS providers must understand the importance of accurate documentation and the technical aspects of the form. Regular training sessions on how to properly fill out the PCR, including coding and legal considerations, ensure that all team members are competent and compliant with best practices in documentation.

Common mistakes

When filling out the Prehospital Care Report (PCR) form, accuracy is crucial for ensuring proper patient care and documentation. It is not uncommon for errors to occur, which can lead to complications down the line. Here are eight common mistakes that people make when completing this important document.

Firstly, many individuals forget to fill in the incident date and incident address. This key information allows for easy tracking of incidents and creating accurate records. Without it, the report may lack context, making it difficult for healthcare providers to understand the timeline and location of care.

Secondly, selecting the wrong incident/patient disposition can create confusion. For instance, marking "Treated & Released" when the patient was actually transported elsewhere misrepresents the care provided. It is essential to carefully evaluate and choose the correct option, as it affects future medical follow-ups and potential billing issues.

Another frequent mistake involves forgetting to document the response mode to the scene. Whether lights and sirens were used or not can significantly affect how the incident is perceived and how care is coordinated. Not capturing this information leaves gaps in communication among emergency services.

Additionally, many people overlook completing the patent medical and medication histories. Neglecting to provide this critical background information can hinder effective treatment. Medications and past medical history could influence the current diagnosis and response, so thoroughness here is vital.

It's also common for responders to miss indicating the primary payment method. This detail is indispensable for hospitals and emergency services to determine how to bill for services rendered. Without this information, there may be delays in processing claims, leading to confusion for patients regarding their responsibilities.

Another pitfall is failing to accurately document vital signs and the Glasgow Coma Scale

Furthermore, many responders make assumptions rather than documenting medication complications or procedure attempts when applicable. Even if no complications occur, it is essential to note that the medications and procedures were administered and monitored, as this assures continuity of care.

Lastly, neglecting to obtain proper patient or guardian signatures for consent can lead to serious issues. If a patient refuses treatment, their signed acknowledgment of that decision is essential to protect both the healthcare provider and the institution from liability.

In closing, careful attention to detail will ensure that the Prehospital Care Report is thorough and accurate. Each section of the form plays a critical role in facilitating effective communication and quality patient care.

Documents used along the form

The Prehospital Care Report (PCR) is a critical component of emergency medical services (EMS) documentation. It provides a detailed account of patient care during emergencies, documenting various essential elements. Along with the PCR, other forms and documents play vital roles in capturing and managing patient data, ensuring appropriate care, and facilitating communication among healthcare providers. Below is a list of the documents commonly used in conjunction with the Prehospital Care Report.

Patient Consent Form: This document secures permission from the patient or their guardian for medical treatment and services. It outlines the nature of the treatment and any associated risks.
Transfer of Care Form: This form is used during the handoff of patient care between EMS personnel and the receiving medical facility. It ensures that critical information is communicated effectively.
Medication Administration Record (MAR): This record details the medications administered to the patient, including dosages and times. It helps manage medication safety and provides a clear history of treatment.
Trauma Assessment Form: Used specifically for trauma patients, this form evaluates injuries sustained and provides critical information regarding the patient's condition at the scene.
Vital Signs Record: This document tracks and records a patient's vital signs over time, providing essential data that can influence patient care decisions.
Incident Report: An official summary of the emergency incident, including details about the event, response times, and actions taken. This report is vital for quality assurance and applicable for legal considerations.
EHR (Electronic Health Record) Integration Form: When available, this form connects EMS data to electronic health records, improving continuity of care and streamlining information access across healthcare systems.
Insurance Information Form: This document gathers necessary insurance details to facilitate billing and claims processing, ensuring that financial responsibilities are clear from the start.
Field Treatment Guidelines or Protocols: These guidelines provide EMS personnel with essential protocols and procedures to follow during patient care, ensuring adherence to best practices and regulatory standards.

These documents, alongside the Prehospital Care Report, create a comprehensive framework that aids in the effective delivery of emergency medical services. Ensuring that all necessary forms are completed helps safeguard patient care and enhances communication among all parties involved in a patient’s treatment journey.

Similar forms

Emergency Medical Services (EMS) Run Report: Similar to the Prehospital Care Report, the EMS Run Report documents the details of an emergency medical call, including the patient's condition, treatments provided, and response times. Both documents serve as a comprehensive record for continuity of care and legal protection.
Patient Care Record (PCR): The PCR captures the clinical details of patient interactions, including assessments, treatments, and outcomes. Like the Prehospital Care Report, it emphasizes patient history and vital signs to inform receiving healthcare providers.
Incident Report: This document records details surrounding the incident itself, including location, time, and circumstances. Its purpose aligns with the Prehospital Care Report in providing a formal account of events for review and analysis.
Ambulance Service Billing Form: Used to document the services rendered and facilitate billing to insurance or the patient. Much like the Prehospital Care Report, it includes relevant patient data and service details crucial for reimbursement.
Transfer of Care Documentation: This form outlines the handoff process when a patient is transferred from one medical provider to another. It parallels the Prehospital Care Report by ensuring that vital patient information is communicated effectively between providers.

Dos and Don'ts

The Prehospital Care Report form is a critical document in emergency medical services. Careful attention to detail is required when filling it out. Here are five essential dos and don'ts to consider:

Do fill out all required fields completely. Ensure that information such as incident date and patient details is accurate.
Don't use abbreviations unless they are standard and widely recognized. This prevents confusion and misinterpretation of important data.
Do document the service type and patient status clearly. For example, specify whether the patient was treated, transported, or refused care.
Don't omit crucial patient information, especially regarding medications, allergies, and medical history. This information can impact treatment and outcomes.
Do ensure that signatures are obtained where necessary, especially from the patient or guardian for consent. This protects both the service provider and the patient.

Misconceptions

Understanding the Prehospital Care Report (PCR) form is essential for ensuring efficient and accurate documentation of emergency medical services. However, several misconceptions can cloud its use. Here are ten common misconceptions about the PCR form:

The PCR form is only for ambulance services. Many believe that only ambulance personnel use this form. In reality, various emergency medical providers and services document care using the PCR format.
All information on the PCR form is mandatory. While certain fields are required, not all sections need to be filled out for every report. Depending on the situation, some fields may be left blank.
The form is only used after a transport occurs. Some think that PCR forms are exclusively for incidents involving patient transport. However, they are also applicable for patients who refuse care or when no treatment is required.
Only paramedics fill out the PCR. It’s a misconception that only paramedics are responsible for completing this form. EMTs and other trained personnel also have the authority to complete the PCR.
The PCR does not impact patient care. Some may assume that the information on the PCR is inconsequential. In fact, this documentation is vital for continuity of care and informs other healthcare providers about the patient’s condition and treatment.
A single PCR can accurately represent multiple patients. Many believe one PCR can cover multiple patients in a single incident. Each patient involved in an incident requires their own separate PCR for accurate documentation.
The PCR form is filled out only at the scene. Some think that documentation is limited to the incident location. In truth, additional details can be noted en route to the hospital if needed.
Patient privacy is not considered in the PCR. It is a common belief that personal patient information is not safeguarded. However, the PCR must comply with HIPAA regulations, which protect patient privacy.
The PCR form is only for record-keeping. Many view the form solely as a record. However, it serves as a communication tool among healthcare providers, facilitating a shared understanding of the patient’s care history.
The form is too complex to be completed accurately. Some think the PCR form is overly complicated. While it contains multiple sections, comprehensive training is provided to ensure accuracy and ease of use.

Key takeaways

Properly filling out the Prehospital Care Report (PCR) form is crucial for effective communication and documentation in emergency medical services (EMS). Here are key takeaways:

Incident Details Are Essential: Begin by documenting the incident date, Oklahoma report number, and relevant EMS agency details. This provides vital context for the report.
Accurate Patient Information: Include comprehensive patient details such as name, address, age, race, and medical history. This information facilitates continuity of care.
Document Treatment and Disposition: Clearly indicate the patient’s disposition, such as whether they were treated, transported, or refused care. This helps establish the intervention's outcome.
Time Tracking is Critical: Record all times associated with the response, including arrival at the scene and departure. Accurate timing can be essential for quality assurance and legal purposes.
Assessment of Chief Complaints: Clearly document the patient's chief complaints and any symptoms reported. This forms the basis for the patient's immediate medical needs.
Medication and Procedures Log: Include detailed information about any medications administered and procedures performed. This ensures thorough medical records and helps in preventing errors.
Use of Reference Sheets: Make effective use of reference sheets for coding condition codes, level of service, and any specific procedures. These ensure accuracy and consistency in reporting.
Analyze Barriers to Care: Note any barriers encountered while providing care, such as language issues or physical restraints. Understanding these can improve future responses.
Signatures Are Mandatory: Ensure that all crew members sign the PCR form. This verifies that the report accurately reflects the care provided and fulfills legal requirements.

Thorough and accurate completion of the PCR form not only improves patient care but also provides legal protection and supports the integrity of the EMS system.

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