ICHART

INCIDENT
Dispatch Reason and Location Type
Age, Gender, Location of Pt
How Pt Found
Pt Level Of Distress
CHIEF COMPLAINT
Chief Complaint At Time Of Transport
Pt Original Complaint If Different From Time Of Transport
Document Sources Of Information (Family, Staff, Pt)
HISTORY
Brief History Of Event Leading To Incident
Facility Diagnosis If Available
Mechanism Of Injury / Nature Of Illness
SAMPLE
ASSESSMENT
AVPU and OPQRST
Important Findings & Result Of Assessment
Pertinent Negatives
Pertinent Vital Signs
RENDERED TREATMENTS
List Of Treatments By Crew In Chronological Order
How Pt Was Transferred To Gurney
All Safety Precautions Taken
Document Reassessments and Monitoring
TRANSPORT
Why the patient required transport by ambulance
Why pt being transported to destination and what service they will receive.
Where Pt Transported And Any Changes En Route
Identity Of Person Pt Transferred To.
How Pt Was Transferred From Gurney At The Destination