PCR - Template

[LSCFD]

Date of Issue: 2025-09-23
Date of Revision: NIL

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

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Section 1: Pre-Care Information

Incident Number:
Incident Date:
Incident Address:
Incidence Location Type:
Chief Complaint (Reported by Dispatch):

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Section 2: Emergency Services

MIST Report

M - Mechanism of action:

I - Injuries:
Identified injuries below;

Suspected injuries below;

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

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

T - Treatment provided:

SAMPLE Report

S - Signs/symptoms:

A - Allergies if any:

M - Medications if any:

P - Past history if any:

L - Last Oral Intake if any:

E - Events leadng up if any:

Freetext Remarks if any:

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Section 3: Patient Information

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

Patient Name:
Date of Birth:
Age:
Gender:
Patient Address:

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Section 4: Copy paste this, post a new topic under PCR with the correct incident number and details

Code: Select all

[center][img]https://i.imgur.com/p0j07lL.png[/img]
[b]Red County Fire Department (RCFD)[/b]
Patient Care Report (PCR) - XXXX [/center]

[hr][/hr]

[center][b][u]Section 1: Pre-Care Information[/u][/b][/center]

[b]Incident Number:[/b]
[b]Incident Date:[/b] 
[b]Incident Address:[/b] 
[b]Incidence Location Type:[/b] 
[b]Chief Complaint (Reported by Dispatch):[/b] 

[hr][/hr]

[center][b][u]Section 2: Emergency Services[/u][/b][/center]

[center][b]MIST Report[/b][/center]

[b]M - Mechanism of action:[/b]

[b] I - Injuries:[/b]
Identified injuries below;
[list][*]
[/list]

Suspected injuries below;
[list][*]
[/list]

[b]S - Signs/symptoms:[/b]
Signs (what you observe) below;
[list][*]
[/list]

Symptoms (what the patients tells or indicates to you) below;
[list][*]
[/list]

[b]T - Treatment provided:[/b]
[list][*]
[/list]

[center][b]SAMPLE Report[/b][/center]

[b]S - Signs/symptoms:[/b]

[b]A - Allergies if any:[/b] 

[b]M - Medications if any:[/b] 

[b]P - Past history if any:[/b] 

[b]L - Last Oral Intake if any:[/b] 

[b]E - Events leadng up if any:[/b] 

[b][u]Freetext Remarks if any:[/u][/b] 

[hr][/hr]

[center][b][u]Section 3: Patient Information[/u][/b][/center]

[b][center][color=#FF0000]*** WARNING: The following information is confidential under HIPAA Act of 1996! ***[/color][/center][/b]

[b]Patient Name: [/b]
[b]Date of Birth: [/b]
[b]Age: [/b]
[b]Gender: [/b]
[b]Patient Address:[/b]