PCR - #000 (Example)

[LSCFD]

Date of Issue: 2025-09-23

Red County Fire Department (RCFD)
Patient Care Report (PCR) - XXXX

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Section 1: Pre-Care Information

Incident Number: 001.
Incident Date: 2025-09-24.
Incident Address: Blueberry Acres.
Incidence Location Type: On the field acres, next to a tractor.
Chief Complaint (Reported by Dispatch): Traffic collision (TC), passenger vehicle vs tractor.

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Section 2: Emergency Services

MIST Report

M - Mechanism of action: TC.

I - Injuries:
Identified injuries below;

• Abrasions and contusions anterior face.
• Swelling right-side cheek and jawbone.

Suspected injuries below;

• Nothing-in-line (NIL).

S - Signs/symptoms:
Signs (what you observe) below;

• Alert, talking coherently.
• Skin presenting normal, color ok, capillary perfusion check ok (<2 sec).
• Respirations normal, respiratory rate (RR) initial 16, later 14 bpm.
• Circulation adequate, bilateral radial pulses at initial 88, later 89 bpm.
• Blood pressure (BP) ok, initial 120/80 mmHg, later 123/81 mmHg
• Peripheral oxygen saturation (SpO2) ok, initial 98%, later 98%.
• Spinal check normal, motor functions intact and responsive, neck precautions still taken.

Symptoms (what the patients tells or indicates to you) below;

• Pain, rated 4/10.
• Nervousness, anxiety.

T - Treatment provided:

• C-spine neck collar as precaution.
• Bandaid for abrasion.
• Ice-pack for contusion/swelling.

SAMPLE Report

S - Signs/symptoms: See above.

A - Allergies if any: NIL.

M - Medications if any: NIL.

P - Past history if any: NIL.

L - Last Oral Intake if any: NIL, patient states no medications taken.

E - Events leadng up if any: Patient states she was driving, unobservant for a second.

Freetext Remarks if any: NIL.

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Section 3: Patient Information

*** WARNING: The following information is confidential under HIPAA Act of 1996! ***

Patient Name: Jane Doe.
Date of Birth: 1994/08/24.
Age: 31.
Gender: F.
Patient Address: Example Road 1, Dillimore, RC, SA.