SAFR CAD | Refusal Care Form

The Following Items: - Form Number / Report Number - Date / Time - Postal / Location / Primary Complaint - Patient Information (Search from CAD) - Assessment -- Blood Pressure (Number) -- Heart Rate (Number) -- Respiratory Rate (Number) -- SpO2 (Number) -- Is PT Alert / Oriented (Dropdown: Yes, No, Unknown, Other) -- Is PT Injured (Dropdown: Yes, No, Unknown, Other) -- Signs of Intox (Dropdown: Yes, No, Unknown, Other) -- Signs of Altered Mental Status (Dropdown: Yes, No, Unknown, Other) - Disclosure -- PT is 18+ or Legal Guardian Present (Dropdown: Yes, No, Unknown, Other) -- PT is not under the influence of drugs or Alcohol (Dropdown: Yes, No, Unknown, Other) -- PT Was Given Info to Call EMS Again (Dropdown: Yes, No, Unknown, Other) -- PT is Mentally Competent (Dropdown: Yes, No, Unknown, Other) -- PT was offered Transport (Dropdown: Yes, No, Unknown, Other) -- PT refused all Recommendations (Dropdown: Yes, No, Unknown, Other) -- Signature of PT (Signature) - Narrative - Crew Information -- Crew Name / Ident / Agency / Signature