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Demo chart

Sample Patient Care Record

Patient

Name

Jane Doe

DOB

03/14/1948

MRN

EMS-2026-04417

Narrative

Chief complaint narrative

Pt is a 78yo F at SNF c/o substernal chest pressure x 2hr, 7/10. Pt sitting upright in bed, A&Ox4, skin pale and diaphoretic. Vitals obtained. Pt transported to St. Mark's ED without incident. Care transferred to RN at bedside.

Signatures

Patient signature (AOB)

(not signed)

Authorized rep signature

(not signed)

Facility signature

Dr. M. Reyes — 02/15 14:22

PCS form

(not attached)

Times

Dispatched