Clinical Aviations

Mission Info

Patient Info

Personnel

Clinical

Submit

1. Operating Base

2. Type of Transport

3. Date of Flight

4. Mission / Trip Number

5. Was any part of the mission operated as a "Night Flight"? (6pm – 6am)

6. Scene time in minutes (Patient Contact to Depart Scene)

7. Patient Population

8. Patient Gender

9. Patient Type

10. Chief Complaint / Provider Impression

11. Primary AMC Full Name

12. Primary AMC Employee Number

13. Secondary AMC Full Name

14. Secondary AMC Employee Number

15. Other AMC Full Name (if applicable)

16. Other AMC Employee Number (if applicable)

17. Chart Reviewer Last Name

18. Was the clinical pathway activated?

19. If Yes, who activated the pathway?

20. Did the AMC document three (3) complete sets of vital signs including assessment of mental status?

21. Did the patient have an altered mental status or a focal neurologic deficit?

22. If Yes above, was a blood glucose documented? (Use N/A if Q21 is "No")

23. Did AMC establish IV/IO access?

24. Did the AMC administer medications?

25. Did the AMC document a pain assessment using an appropriate pain scale?

26. Initial Pain Score

27. Was pain rated >3 managed appropriately?

Please confirm all information is correct before submitting.

You are about to submit a Chart Review for Rotor Wing Operations. Once submitted, the record will be visible in the admin dashboard.