PCR Narrative Builder
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I. Call type
Call type:
Select…
unknown
sick
trauma
injury
II. Subjective
Age:
Gender:
Select…
Male
Female
X
Level of consciousness:
conscious, alert, breathing
conscious, breathing
unconscious, breathing, carotid pulse?
unconscious, not breathing, carotid pulse?
Position found:
Select…
standing
sitting in chair
semi-Fowler's in bed
prone
in recovery position
Distress level:
none
mild
moderate
severe
Chief complaint (with start time): Pt reports…
Conditions
Head, neck, back, bain:
reports
denies
Headache:
reports
denies
Chest pain:
reports
denies
Shortness of breath:
reports
denies
Loss of consciousness:
reports
denies
Head strike:
reports
denies
Dizziness, nausea, vomiting:
reports
denies
Taking blood thinners:
reports
denies
Pain scale (0-10):
Select…
0 - No pain
1
2
3
4
5
6
7
8
9
10 - Worst pain ever felt
Alcohol consumption:
Select…
reports
denies
Number of drinks:
When:
PMHx:
Select…
reports
denies
Details:
III. Objective assessment
Mental status:
Select…
A&Ox4 (Alert & Oriented to person, place, time, and situation)
A&Ox3
A&Ox2
A&Ox1
alert to voice
alert to pain
unresponsive
Physical exam
Positive patent airway:
yes
no
N/A
Respiratory effort regular and unlabored:
yes
no
N/A
Positive distal pulses:
yes
no
N/A
No obvious sign of hemorrhage:
yes
no
N/A
HEENT intact:
yes
no
N/A
PERRL:
yes
no
N/A
ABD SS/NT/NDx4 quadrants:
yes
no
N/A
Positive PMSx4 extremities:
yes
no
N/A
Gait steady:
yes
no
N/A
IV. Transport
Destination hospital:
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