Patient Assessment & Soap Note Template Page 2
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1
2Rescue Request
Vital Sign Record
Heart Rate
Respiratory Rate
Quadrangle/Coordinates
Time
Skin
LOR
BP
Area Description
Character:
Character:
Strong
Deep
Color
Weak
Shallow
Date
Regular
Noisy
Temperature
Blood
Stay Put
Evacuate to trail to road to local shelter
AVPU
Hour
Irregular
Labored
Moisture
Pressure
Will send some members out
Notes:
Food
Water
Shelter
Stove and Fuel
Sleeping Bags
Climbing Hardware
Rope
Notes:
Temp:
Hot
Warm
Cold
Freezing
Precip:
Dry
Intermittent Rain
Rain
Snow
Notes:
Lowering Operating
Carry Out
Rigid Stretcher
Helicopter
None until specialized medical assistance
Notes:
Name
Notify
Phone
Focused Spine Exam: Date__________ Time___________ Patient Assessment/History Complete______
Reliable (A+0x3, Sober, No Distract Injury)______ CSM (4 Extremities)______ No Spine Tenderness______
DBB 11/01/07
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