CC:
SOURCE:

HPI:

PMHx:
ALLERGIES:
MEDICATIONS:
SOCIAL Hx:
FAMILY Hx:

VITALS: BP = / | HR = | RR = | SpO2 = % | GCS = | BGL = mg/dL | TEMP = F°

GENERAL:
HEENT:
SKIN:
CHEST:
ABDOMEN:
PELVIS:
SPINE:
EXTREMITIES:
NEURO:

ASSESSMENT:

PLAN/TREATMENT:

DISPOSITION/TRANSPORT:

OTHER NOTES: