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Get Resuscitationrecord Sheet Form

Ime Name called arrived Patient Tag/Sticker Date of Birth Gender : 1 2 3 Present upon Pt arrival? General Surgeon EMS report in Pt chart No : : Yes No : : Yes No : Transfer from: Yes Anesthesia Arrived via: Ambulance Helicopter Police Self : ED Physician Medical Record # : : Yes No Pt. Medications Pre-hospital Interventions Airway: Oral Nasal Intubated O2 IV size site IV #2 size site Blood sugar mg/dl CPR LBB C collar MAST Splin.

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