Form Elements and Fields
When you design a form, you can select and modify elements and fields. Elements are groups of one or more fields with a common theme. You can select the elements displayed on the form and identify which fields are shown, required, labeled, or include tooltips. Some elements and fields may vary slightly on different types of forms, like the Web - Add, Web - Edit, and Mobile forms.
Fields that are formatted with a configurable list must have entries in the associated data element
Fields and values as they appear in EMTrack Web and Mobile. to populate the field options.
You can add the following elements to forms:
Address
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Country |
Country in which the person's residence is located. |
List of countries |
Show Required Label Tooltip Default |
|
Address 1, Address 2 |
Street name and number of the person's residence. |
Free text; format may be restricted by country |
Show Required Label Tooltip |
|
City |
City in which the person's residence is located. |
Free text; format may be restricted by country |
Show Required Label Tooltip |
|
State |
State in which the person's residence is located. |
Free text and/or list of US state abbreviations; format may be restricted by country |
Show Required Label Tooltip |
|
ZIP/Postal Code |
ZIP Code™ in which the person's residence is located. |
Free text; format may be restricted by country |
Show Required Label Tooltip |
|
Temporary Address |
Is the address provided temporary in nature? |
Yes, No |
Show Label Tooltip |
Age
Available onWeb - Add,Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Age |
Number that represents the person's age in the selected units. |
Number between 0-120; used in conjunction with a selected unit |
Show Required Label Tooltip Approximate |
|
(Unit) |
Quantity of time used as a measure of age. |
Years Months Days Hours |
-- |
|
Approximate Age (only appears if selected in Age configuration options) |
Indicates the age entered is an estimate that could not be verified. |
checkbox |
-- |
|
Date of Birth |
Day, month, and year the person was born. If entered, the person's age is calculated automatically. |
mm/dd/yyyy |
Show Required Label Tooltip |
Alert Type
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Alert Type |
Label that identifies the patient's condition or status on prehospital and incoming patient notifications. |
|
Required Label Add Custom Values |
Allergies
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Medication Allergies |
Indicates any abnormal reaction the person experiences in response to medications. |
Configurable list and/or free text |
Show Required Label Tooltip |
|
Environmental/Food Allergies |
Indicates any abnormal reaction the person experiences in response to natural or synthetic materials or food items. |
Configurable list and/or free text |
Show Required Label Tooltip |
Alternate ID
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Alternate ID |
Information about a secondary identification number. |
-- |
Label Tooltip |
|
Name |
Name of the alternate identification. |
Free text |
-- |
|
Description |
Description of the alternate identification. |
Free text |
-- |
|
+ Add |
Option to add another alternate identification. |
Button |
-- |
Appliances
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Appliances |
Functional or therapeutic devices located on or with the person. |
Free text and/or configurable list |
Required Label Tooltip |
Backboard
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Backboard |
Was a backboard used to move the person? |
Yes, No |
Label Tooltip |
Chief Complaint
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Complaint Category |
Category that best describes the person's primary complaint. |
Configurable list |
Required Label Tooltip |
|
Complaint Description |
More information about the person's primary complaint. |
Free text |
Show Required Placeholder |
Client Type
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Client Type |
Identifies the client as being either a patient or person depending on the situation and need. |
Patient, Person |
Label Tooltip Default Value Hidden |
Clothing
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Shirt |
Color, type, and/or style of shirt on the person. |
Free text |
Show Required Label Tooltip |
|
Pants/Skirt |
Color, type, and/or style of pants or skirt on the person. |
Free text |
Show Required Label Tooltip |
|
Shoes |
Color, type, and/or style of shoes on the person. |
Free text |
Show Required Label Tooltip |
Contaminated
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Contaminated |
Was the person exposed to some type of contaminant? |
Unknown, Yes, No |
Required Label Tooltip |
|
Description (only appears if Contaminated = Yes) |
Additional information about the contamination. |
Free text |
Required Label |
|
Decontaminated (only appears if Contaminated = Yes) |
Was a decontamination process completed on the person? |
Yes, No |
Show Label Tooltip |
|
When (only appears if Decontaminated = Yes) |
When was the decontamination process performed? |
mm/dd/yyyy hh:mm |
Required Label Tooltip |
Current Location
Available on Web - Add and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Current Location |
Site or facility where the person is located. |
Configurable list |
Required Label |
|
Sub Location |
Secondary location or sub-site where the person is located. |
Configurable list |
Show Label |
|
Comments |
Additional information the user feels would be helpful to document. |
Free text |
Show Label |
Destination Location
Available on Web - Add and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Destination Location |
Site or facility to which the person is being transported. |
Configurable list |
Required Label Tooltip |
|
Sublocation |
Secondary location or sub-site to which the person is being transported. |
Configurable list |
Show Label |
|
Comment |
Additional information the user feels would be helpful to document. |
Free text |
Show Label |
|
Provider |
Agency responsible for transporting the person. |
Configurable list |
Label |
|
Provider Unit |
Agency unit responsible for transporting the person. |
Free text |
Required Label |
|
ETA |
Estimated time of arrival at the destination location. |
Free text and/or configurable list |
Show Required Label |
Disposition
Available on Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Disposition |
Result of the encounter (for example, transported, bandaged and released, or admitted to hospital). |
Configurable list |
Required Label |
Driver License
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Driver License |
Opens a function that scans barcodes on state-issued driver license identification cards. |
Button |
Label Tooltip |
|
Driver License Number |
Unique license number assigned to the driver. |
Free text |
Show Required Label Tooltip |
|
Driver License State |
State that issued the driver license. |
Configurable list |
Show Required Label Tooltip |
Email
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
|
Electronic mail address at which the person can be contacted. |
Email address format. |
Required Label Tooltip |
Equipment
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Type |
Equipment used on or transported with the person. |
Configurable list |
Label Tooltip |
|
Description |
Description of the equipment. |
Free text |
-- |
|
+ Add |
Option to add another piece of equipment. |
Button |
-- |
Ethnic Background
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Ethnic Background |
Category of people that the person identifies with, usually based on a shared social, cultural or national heritage. |
Free text and/or configurable list |
Required Label Tooltip |
Files
Available on Web - Edit forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Type |
Type of file. |
Button |
Label |
|
File |
File name. |
|
Label Tooltip |
|
Label |
Relevant labels or tags that might help users identify files. |
Button |
Label Tooltip |
|
Primary |
Indicates if it is the main file associated with the person. |
checkbox |
Label Tooltip |
|
Description |
Description of the file. |
Free text |
Label Tooltip |
|
Added By |
Person who added the file. |
-- |
Label |
|
Added At |
Location at which the person added the file. |
-- |
Label |
|
Actions |
Indicates if action is required related to the file. |
-- |
-- |
|
+ Add |
Option to add another piece of equipment. |
Button |
-- |
Found with Objects
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Found with Objects |
Objects found with the person, such as glasses, jewelry, or a wallet. |
Free text |
Label Tooltip |
Gender
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Gender |
Whether the person is male or female. |
Configurable list |
Required Label Tooltip |
GPS
Available on Web - Add and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
GPS |
Global positioning system that determines location. |
-- |
Label Tooltip |
|
Lat. |
North-south position used to geocode the person's location. |
Free text |
-- |
|
Long. |
East-west position used to geocode the person's location. |
Free text |
-- |
|
Acquire |
Opens a function that identifies the latitude and longitude of your current location. |
Button |
-- |
Height
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Height |
Measurement of the person from head to foot while standing. |
Number between 0-9 in US customary feet (ft) and 0-11 inches (in); or number between 0-300 in metric centimeters (cm) |
Label Tooltip Unit conversion Default units |
Housing
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Housing Type |
Type of shelter or lodging in which the person resides. |
Free text and/or configurable list |
Show Label Tooltip |
|
Permanent Home Destroyed |
Was the person's permanent home destroyed? |
Yes, No |
Show Label Tooltip |
Identifying Marks
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Description |
Information about marks and/or features on the person that might help to identify or distinguish them. |
Free text |
Label Tooltip |
|
+ Add |
Option to add another identifying mark. |
Button |
-- |
Immunization History
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Immunization History |
Retrieves personal protected health information to provide insight into a patient's previous immunizations. |
-- |
Label Tooltip |
Incident Involvement
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Incident Involvement |
Incident with which the person is associated. |
Configurable list |
Required Label Tooltip |
Insurance
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
| Insurance | Information about the person's health insurance. | -- | Label |
|
Provider Name |
Name of the insurance provider. |
Free text |
Show Required Label Tooltip |
|
Subscriber Number |
Number of the insurance policy or membership through which the person is covered. |
Free text |
Show Required Label Tooltip |
|
Primary Card Holder |
Name of the primary card holder of the insurance through which the person is covered. |
Free text |
Show Required Label Tooltip |
|
Group Number |
Number of the insurance group through which the person is covered. |
Free text |
Show Required Label Tooltip |
| Insurance Plan ID | Identification number associated with the insurance plan. | Free text |
Show Label Tooltip |
| Insurance Company ID | Identification number associated with the insurance company. | Free text |
Show Label Tooltip |
Isolation Status
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Isolation Status |
Types of isolation that might be used during triage and transport of the person. |
Configurable list |
Required Label Tooltip |
|
Reason |
Explanation as to why isolation is needed for the person. |
Free text |
Show Required Label |
Lab Results
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Date and Time |
According to organization policy, day, date, and time the lab was taken or results were presented. |
mm/dd/yyyy hh:mm |
-- |
|
Type |
Type of laboratory test administered. |
List |
-- |
|
Results |
Information provided as a result of the test. |
Free text |
-- |
|
+ Add |
Option to add another lab. |
Button |
-- |
Labels
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Labels |
Conditions, treatments, or other commonly used ways to identify and search for a person or person's status. |
Configurable list |
Required Label Tooltip Multi-select |
Languages
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Languages Spoken |
What languages does the person speak? |
Free text and/or configurable list |
Show Label Tooltip |
|
Translation Required |
Is a translator necessary for communication? |
Free text and/or configurable list |
Show Label Tooltip |
Location on Body
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Location on Body |
Site on the person's body that is affected. |
Configurable list |
Label Tooltip |
Medical History
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Medical History |
Information about previous medical conditions and procedures. |
Configurable list |
Required Label Tooltip |
Medical Record Number
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
PCR # |
Unique number issued to identify the person's Patient Care Record (PCR). |
Free text |
Show Required Label |
|
EMR # |
Unique number issued to identify the person's Electronic Medical Record (EMR). |
Free text |
Show Required Label |
Medication Supply
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Description |
Name of and information about medications the person uses. |
Free text |
Label Tooltip |
|
Supply |
Number of doses, in days, that are being transported with the person. |
Free text |
-- |
|
+ Add |
Option to add another medication. |
Button |
-- |
Medications Administered
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Updated Time |
Time the medication was administered. |
mm/dd/yyyy hh:mm |
Label Tooltip |
|
Medication |
Name of the medication administered. |
Configurable list |
-- |
|
More |
Opens a window with the following fields: Dose, Amount, Route, Sites, Administered By, Ordered By, Reaction, State Administered, Lot #, Manufacturer, Expiration Date, Comment. |
Free text |
-- |
|
+ Add |
Option to add another medication. |
Button |
-- |
Name
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
First Name |
Given name of the person. |
Free text |
Required Label Tooltip |
|
Middle Name |
Additional given name of the person. |
Free text |
Show Required Label Tooltip |
|
Last Name |
Family name of the person. |
Free text |
Required Label Tooltip |
| Maiden Name | Last name the person used prior to legally changing it at marriage. | Free text |
Show Label Tooltip |
| Mother's Maiden Name | Last name the person's mother used prior to legally changing it at marriage. | Free text |
Show Label Tooltip |
Nationality
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Nationality |
Country in which the person has citizenship. |
Configurable list |
Required Label Tooltip |
Occupation
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Occupation |
Type of employment or work in which the person is engaged. |
Free text |
Show Required Label Tooltip |
|
Uniform |
Distinctive clothing associated with the person's occupation. |
Configurable list |
Show Required Label Tooltip |
|
Badge Number |
Emblem and assigned number that identifies the person's occupation, membership and office. |
Configurable list |
Show Required Label Tooltip |
|
Assigned Unit |
Group to which the person is assigned. |
Configurable list |
Show Required Label Tooltip |
|
Rank |
Relative standing or position of membership. |
Configurable list |
Show Required Label Tooltip |
Personal Characteristics
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Eye Color |
Color of the person's iris. |
Free text |
Show Required Label Tooltip |
|
Hair Color |
Color of hair on the person's head. |
Free text |
Show Required Label Tooltip |
|
Hair Length |
Length of hair on the person's head. |
Free text |
Show Required Label Tooltip |
|
Facial Hair |
Whether the person has some type of hair on their face, chin, and/or neck |
Free text |
Show Required Label Tooltip |
|
Skin Color |
Color of the person's skin. |
Free text |
Show Required Label Tooltip |
Phone Number
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Phone Number |
Phone number associated with the person. |
Free text; format may be restricted by country |
Required Label Tooltip |
|
Phone Type |
Type of phone the number is associated with. |
Free text |
Show Required Label Tooltip |
Photos
Available on Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Photos |
Allows user to take and upload photos associated with the person, location, or situation. |
Button |
-- |
Pre-Screening Questions
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Pre-Screening Questions |
Questions asked to determine the person's health and ability to receive a treatment or vaccination. |
Configurable list - yes/no or numeric |
Label Tooltip |
Procedures Performed
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Updated Time |
Day, date, and time at which the procedure was performed. |
mm/dd/yyyy hh:mm |
Label Tooltip |
|
Procedure |
Name of the procedure performed. |
Configurable list |
-- |
|
More |
Opens a window with the following fields: Results, Administered By, Ordered By, Reaction, State Administered. |
Free text |
-- |
|
+ Add |
Option to add another procedure. |
Button |
-- |
Property
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
ID# |
Number or code that identifies property in the person's possession. |
Free text |
Label Tooltip |
|
Contact |
Main person responsible for the property. |
Free text |
Show Label |
|
Description |
Description of the property. |
Free text |
Label Tooltip |
|
Location |
Property source or home location. |
Configurable list |
Label Tooltip |
|
Location Comment |
Additional information provided at the source or home location. |
Free text |
Show Label Tooltip |
|
Destination |
Property destination location. |
Configurable list |
Show Label Tooltip |
|
Destination Comment |
Additional information provided at the destination location. |
Free text |
Show Label Tooltip |
|
Destination Contact |
Person responsible for the property at the destination location. |
Free text |
Show Label Tooltip |
|
Returned to Owner |
Was the item successfully returned to its owner? |
checkbox |
Show Label Tooltip |
Relatives
Available on Web - Edit forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
ID# |
Unique identification number that is generated when the person's triage tag is scanned. |
Free text |
Show Label Tooltip |
|
Relationship |
Description of the familial relationship between the relative and the person. |
Free text
|
Label Tooltip |
|
First Name |
Given name of the relative. |
Free text |
Label Tooltip |
|
Middle Name |
Additional given name of the relative. |
Free text |
Show Label Tooltip |
|
Last Name |
Family name of the relative. |
Free text |
Label Tooltip |
|
Country |
Country in which the relative's residence is located. |
List of countries |
Show Label Tooltip |
|
Address |
Primary street name and number of the relative's residence. |
Free text |
Show Label Tooltip |
|
City |
City in which the relative's residence is located. |
Free text |
Show Label Tooltip |
|
State |
State in which the relative's residence is located. |
Free text and/or list of US state abbreviations |
Show Label Tooltip |
|
ZIP/Postal Code |
ZIP Code™ in which the relative's residence is located. |
Free text |
Show Label Tooltip |
|
Phone Number |
Phone number associated with the relative. |
Free text |
Show Label Tooltip |
|
|
Electronic mail address at which the person can be contacted. |
Email address format. |
Show Label Tooltip |
|
Comments |
Additional information the user feels would be helpful to document. |
Free text |
Show Label Tooltip |
Sepsis
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
History of Suggestive Infection |
Symptoms or conditions that might indicate the presence of infection. |
List |
Required Label |
Screening Questions
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Screening Question |
Questions asked to determine the patient's health and ability to receive a treatment or vaccination. |
Configurable list - yes/no or numeric |
Label Tooltip |
Signature
Available on Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Signature |
Allows the user to collect written consent from the patient by creating a signature on the mobile device. |
Button |
Label Tooltip |
STEMI
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
ECG: Acute MI Suspected |
Clinical opinion of possible myocardial infarct based on ECG results. |
|
-- |
|
Infarct Location |
Indicates arterial location of blockage or damage. |
|
-- |
|
Bundle Branch Block |
Indicates blockage or delay in the electrical conduction system of the heart. |
|
-- |
|
Onset Time |
Day, date, and time symptoms of the current ST-Elevation Myocardial Infarction were first noticed. |
|
-- |
|
Cardiologist or Group |
Symptoms or conditions that might indicate the presence of infection. |
Free text |
-- |
Stroke
Available on Web - Add, Web - Edit, and Mobile forms.
Cincinnati Prehospital Stroke Scale (CPSS)
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Facial Droop |
Evaluation of facial weakness or paralysis. |
|
-- |
|
Arm Drift |
Evaluation of patient's ability to extend arms, palms up. |
|
-- |
|
Speech |
Evaluation of patient's speech. |
|
-- |
|
Last Known Well |
Day, date, and time the patient last felt well. |
|
-- |
Los Angeles Motor Scale (LAMS)
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Facial Droop |
Evaluation of facial weakness or paralysis. |
|
-- |
|
Arm Drift |
Evaluation of patient's ability to extend arms, palms up. |
|
-- |
|
Grip |
Evaluation of patient's ability to grip. |
|
-- |
|
LAMS Score |
Score based on answers provided in assessment. |
Dynamic calculation |
-- |
|
Last Known Well |
Day, date, and time the patient last felt well. |
|
-- |
SSN
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
SSN |
United States (US) government issued Social Security Number (SSN) of the person. |
Free text - nine numeric characters |
Required Label Tooltip |
Symptoms
Available on Web - Add, Web - Edit, and Mobile forms.
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Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
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Symptoms |
Physical or mental features regarded as a condition of disease. |
Free text and/or configurable list |
Label Tooltip |
|
Comments |
Additional information the user feels would be helpful to document. |
Free text |
Show Label |
Tracking Number
Available on Web - Add and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
ID# |
Unique identification number that is generated when the person's triage tag is scanned. |
Free text |
Label Tooltip |
|
Tracking Number |
Unique identification number that is generated when a record is created. Usually reserved for situations in which triage tags are not used. A minimum length can be specified. |
List |
Do not generate Generate and hide Generate and show |
Trauma
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Anatomy of Injury |
Evaluation of the type and extent of injuries, with two options: Not Recorded and Select from List. |
List:
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-- |
|
Mechanism of Injury |
Cause or reason for the injury, with two options: Not Recorded and Select from List. |
List:
|
-- |
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Special Considerations |
Other factors or considerations that impact care and the patient's outcome, with two options: Not Recorded and Select from List. |
List:
|
-- |
Treatment Level
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Treatment Level |
Level of care provided (Basic Life Saving or Advanced Life Saving). |
BLS, ALS |
Required Label Tooltip |
|
Comments |
Additional information the user feels would be helpful to document. |
Free text |
Show Required Placeholder |
Triage Category
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Triage Category |
Standard medical triage categories that identify the priority of care required by the person. |
Configurable list |
Required Label Tooltip |
Vital Signs
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Vital Signs |
Clinical measurements that indicate the relative health of the person, with three general options: Unspecified, Stable, and Unstable. |
Configurable table containing the fields listed below. |
Show Required Label Tooltip |
|
Date and Time Measured |
Date and time vital signs were measured. |
mm/dd/yyyy hh:mm |
-- |
|
Blood Pressure |
Pressure of the blood in the circulatory system. |
2 numbers between 0-500, one over the other (systolic/diastolic). For example, 120/80
|
Show Required Label Tooltip |
|
Pulse |
Heart rate per minute. |
Number between 0-500 |
Show Required Label Tooltip |
|
Respiration |
Breaths per minute. |
Number between 0-300 |
Show Required Label Tooltip |
|
SpO2 |
Blood oxygen level. |
Number between 0-100 |
Show Required Label Tooltip |
|
Temperature |
Body temperature. |
Number between 0-122 with one decimal place in degrees Fahrenheit (°F) or number between 0-50 with one decimal place in degrees Celsius (°C) |
Show Required Label Tooltip Default scale |
|
End Tidal CO2 |
Concentration of carbon dioxide in an exhaled breath. |
Number between 0-200 |
Show Required Label Tooltip |
|
Pain |
According to organization policy, level of pain the patient is experiencing. |
Number between 0-10 |
Show Required Label Tooltip |
|
Blood Glucose |
Amount of glucose or sugar in the blood. |
Free text numeric |
Show Required Label Default Scale |
|
Glasgow Coma Scale (GCS) |
Neurologic scale to evaluate the patient's consciousness. |
Lists:
|
Show Required Label Tooltip |
|
AVPU |
Neurologic scale to evaluate the patient's consciousness. |
Lists:
|
Show Required Label Tooltip |
Weight
Available on Web - Add, Web - Edit, and Mobile forms.
|
Fields |
Description |
Format |
Configuration Options |
|---|---|---|---|
|
Weight |
Amount the person weighs. |
Number between 0-2000 in US customary pounds (lbs) or number between 0-1000 in metric kilograms (kg) |
Required Label Tooltip Default units |