NEMSIS v3.5.0 EMSDataSet Test Case

 

NEMSIS V3 Test Case for Pre-testing
ID:               2024-EMS-5-PediatricAnxiety_v350
Description:      Test case for pediatric anxiety attack.
Expected Result:  PASS

 
Element Value
EMSDataSet - Root Tag For Patient Care Report Dataset
Header - Header for file
DemographicGroup - Demographic information related to this agency
dAgency.01 - EMS Agency Unique State ID EMS Agency Unique State ID A078
dAgency.02 - EMS Agency Number EMS Agency Number 350-A078
dAgency.04 - EMS Agency State EMS Agency State Colorado
PatientCareReport - Container Tag to hold each instance of a patient care report (PCR) [UUID = [Your UUID]]
eRecord - Patient Record Information
eRecord.01 - Patient Care Report Number [Your Patient Care Report Number]
eRecord.SoftwareApplicationGroup - Group Tag to hold information about the software used to generate this patient care report
eRecord.02 - Software Creator [Your Software Creator]
eRecord.03 - Software Name [Your Software Name]
eRecord.04 - Software Version [Your Software Version]
eResponse - Unit Agency Information
eResponse.AgencyGroup - Group Tag to hold EMS agency number and name
eResponse.01 - EMS Agency Number 350-A078
eResponse.02 - EMS Agency Name [Value from DEMDataSet]
eResponse.03 - Incident Number 350-2024-EMS5
eResponse.04 - EMS Response Number 350-2024-EMS5-1
eResponse.ServiceGroup - Group Tag to hold details about EMS category of service and the stand by reason
eResponse.05 - Type of Service Requested Emergency Response (Primary Response Area)
eResponse.07 - Unit Transport and Equipment Capability Ground Transport (ALS Equipped)
eResponse.08 - Type of Dispatch Delay None/No Delay
eResponse.09 - Type of Response Delay None/No Delay
eResponse.10 - Type of Scene Delay None/No Delay
eResponse.11 - Type of Transport Delay [NV = Not Applicable]
eResponse.12 - Type of Turn-Around Delay None/No Delay
eResponse.13 - EMS Vehicle (Unit) Number G194
eResponse.14 - EMS Unit Call Sign Medic 1
eResponse.16 - Vehicle Dispatch Location Poudre Valley Hospital Office
eResponse.17 - Vehicle Dispatch GPS Location 40.572568,-105.057274
eResponse.18 - Vehicle Dispatch Location US National Grid Coordinates 13TDE95159131
eResponse.19 - Beginning Odometer Reading of Responding Vehicle 341401.3
eResponse.20 - On-Scene Odometer Reading of Responding Vehicle 341404.8
eResponse.22 - Ending Odometer Reading of Responding Vehicle 341408.2
eResponse.23 - Response Mode to Scene Non-Emergent
eResponse.24 - Additional Response Mode Descriptors No Lights or Sirens
eDispatch - Dispatch Information
eDispatch.01 - Dispatch Reason Psychiatric Problem/Abnormal Behavior/Suicide Attempt
eDispatch.02 - EMD Performed Yes, With Pre-Arrival Instructions
eDispatch.03 - EMD Card Number 25A1
eDispatch.04 - Dispatch Center Name or ID Fort Collins 911
eDispatch.05 - Dispatch Priority (Patient Acuity) Lower Acuity
eDispatch.06 - Unit Dispatched CAD Record ID 202309154
eCrew - Crew Member Information
eCrew.CrewGroup - Group Tag to hold crew information
eCrew.01 - Crew Member ID 455258 - Declan Collin Renner
eCrew.02 - Crew Member Level Paramedic
eCrew.03 - Crew Member Response Role Primary Patient Caregiver-At Scene
eCrew.CrewGroup - Group Tag to hold crew information
eCrew.01 - Crew Member ID 653148 - Sabryna Charlotte Braun
eCrew.02 - Crew Member Level Emergency Medical Responder (EMR)
eCrew.03 - Crew Member Response Role Driver/Pilot-Response
Other Patient Caregiver-At Scene
eTimes - Call Event Times Information
eTimes.01 - PSAP Call Date/Time October 11, 2023, 16:23:21 GMT-06:00
eTimes.02 - Dispatch Notified Date/Time October 11, 2023, 16:23:21 GMT-06:00
eTimes.03 - Unit Notified by Dispatch Date/Time October 11, 2023, 16:25:53 GMT-06:00
eTimes.04 - Dispatch Acknowledged Date/Time October 11, 2023, 16:26:20 GMT-06:00
eTimes.05 - Unit En Route Date/Time October 11, 2023, 16:28:14 GMT-06:00
eTimes.06 - Unit Arrived on Scene Date/Time October 11, 2023, 16:45:38 GMT-06:00
eTimes.07 - Arrived at Patient Date/Time October 11, 2023, 16:46:40 GMT-06:00
eTimes.08 - Transfer of EMS Patient Care Date/Time [NV = Not Applicable]
eTimes.09 - Unit Left Scene Date/Time October 11, 2023, 17:01:07 GMT-06:00
eTimes.11 - Patient Arrived at Destination Date/Time [NV = Not Applicable]
eTimes.12 - Destination Patient Transfer of Care Date/Time [NV = Not Applicable]
eTimes.13 - Unit Back in Service Date/Time October 11, 2023, 17:01:29 GMT-06:00
eTimes.15 - Unit Back at Home Location Date/Time October 11, 2023, 17:20:43 GMT-06:00
eTimes.16 - EMS Call Completed Date/Time October 11, 2023, 17:22:55 GMT-06:00
ePatient - Patient Information
ePatient.01 - EMS Patient ID 64vi64584
ePatient.PatientNameGroup - Group Tag to hold patient's name
ePatient.02 - Last Name Hayes
ePatient.03 - First Name Dayne
ePatient.04 - Middle Initial/Name Michael
ePatient.05 - Patient's Home Address 423 Tedmon Drive
ePatient.06 - Patient's Home City City of Fort Collins
ePatient.07 - Patient's Home County Larimer County
ePatient.08 - Patient's Home State Colorado
ePatient.09 - Patient's Home ZIP Code 80521
ePatient.10 - Patient's Country of Residence US
ePatient.11 - Patient Home Census Tract 08069000401
ePatient.12 - Social Security Number 523382491
ePatient.13 - Gender Male
ePatient.14 - Race White
ePatient.AgeGroup - Group Tag to hold patient's age information
ePatient.15 - Age 7
ePatient.16 - Age Units Years
ePatient.17 - Date of Birth November 17, 2015
ePayment - Insurance/Payment Information
ePayment.01 - Primary Method of Payment Not Billed (for any reason)
ePayment.08 - Patient Resides in Service Area Resident Within EMS Service Area
ePayment.ClosestRelativeGroup - Group Tag to hold information about patient's relative or guardian
ePayment.23 - Closest Relative/Guardian Last Name Dietrich
ePayment.24 - Closest Relative/ Guardian First Name Barbara
ePayment.26 - Closest Relative/ Guardian Street Address 423 Tedmon Drive
ePayment.27 - Closest Relative/ Guardian City Fort Collins
ePayment.28 - Closest Relative/ Guardian State Colorado
ePayment.29 - Closest Relative/ Guardian ZIP Code 80521
ePayment.30 - Closest Relative/ Guardian Country US
ePayment.31 - Closest Relative/ Guardian Phone Number [PhoneNumberType = Home] 970-380-0947
ePayment.32 - Closest Relative/ Guardian Relationship Appointed Guardian
ePayment.40 - Response Urgency Non-Immediate
ePayment.50 - CMS Service Level BLS
eScene - Incident Scene Information
eScene.01 - First EMS Unit on Scene [NV = Not Applicable]
eScene.06 - Number of Patients at Scene Single
eScene.07 - Mass Casualty Incident No
eScene.08 - Triage Classification for MCI Patient [NV = Not Applicable]
eScene.09 - Incident Location Type Y92.0 - Non-institutional (private) residence as the place of occurrence of the external cause
eScene.10 - Incident Facility Code [NV = Not Applicable]
eScene.11 - Scene GPS Location 40.594908,-105.099378
eScene.12 - Scene US National Grid Coordinates 13TDE91599379
eScene.15 - Incident Street Address 423 Tedmon Dr
eScene.17 - Incident City City of Fort Collins
eScene.18 - Incident State Colorado
eScene.19 - Incident ZIP Code 80521
eScene.20 - Scene Cross Street or Directions Corner of Elm Street
eScene.21 - Incident County Larimer County
eScene.22 - Incident Country US
eScene.23 - Incident Census Tract 08069000401
eSituation - Situation Information
eSituation.01 - Date/Time of Symptom Onset October 11, 2023, 16:05:00 GMT-06:00
eSituation.02 - Possible Injury No
eSituation.PatientComplaintGroup - Group Tag to hold information about patient's complaint
eSituation.03 - Complaint Type Chief (Primary)
eSituation.04 - Complaint Panic attack
eSituation.05 - Duration of Complaint 40
eSituation.06 - Time Units of Duration of Complaint Minutes
eSituation.07 - Chief Complaint Anatomic Location General/Global
eSituation.08 - Chief Complaint Organ System Behavioral/Psychiatric
eSituation.09 - Primary Symptom R45.82 - Worries
eSituation.10 - Other Associated Symptoms R06.00 - Dyspnea, unspecified
R06.02 - Shortness of breath
R45.0 - Nervousness
eSituation.11 - Provider's Primary Impression F41.9 - Anxiety disorder, unspecified
eSituation.12 - Provider's Secondary Impressions [NV = Not Recorded]
eSituation.13 - Initial Patient Acuity Lower Acuity (Green)
eSituation.WorkRelatedGroup - Group Tag to hold patient details if the illness or injury is work related
eSituation.14 - Work-Related Illness/Injury No
eSituation.17 - Patient Activity Y93.C2 - Activity, hand held interactive electronic device
eSituation.18 - Date/Time Last Known Well October 11, 2023, 08:00:00 GMT-06:00
eSituation.20 - Reason for Interfacility Transfer/Medical Transport [NV = Not Applicable]
eInjury - Injury Information
eInjury.01 - Cause of Injury [NV = Not Applicable]
eInjury.02 - Mechanism of Injury [NV = Not Applicable]
eInjury.03 - Trauma Triage Criteria (High Risk for Serious Injury) [NV = Not Applicable]
eInjury.04 - Trauma Triage Criteria (Moderate Risk for Serious Injury) [NV = Not Applicable]
eArrest - Cardiac Arrest Information
eArrest.01 - Cardiac Arrest No
eArrest.02 - Cardiac Arrest Etiology [NV = Not Applicable]
eArrest.03 - Resuscitation Attempted By EMS [NV = Not Applicable]
eArrest.04 - Arrest Witnessed By [NV = Not Applicable]
eArrest.07 - AED Use Prior to EMS Arrival [NV = Not Applicable]
eArrest.09 - Type of CPR Provided [NV = Not Applicable]
eArrest.11 - First Monitored Arrest Rhythm of the Patient [NV = Not Applicable]
eArrest.12 - Any Return of Spontaneous Circulation [NV = Not Applicable]
eArrest.14 - Date/Time of Cardiac Arrest [NV = Not Applicable]
eArrest.16 - Reason CPR/Resuscitation Discontinued [NV = Not Applicable]
eArrest.17 - Cardiac Rhythm on Arrival at Destination [NV = Not Applicable]
eArrest.18 - End of EMS Cardiac Arrest Event [NV = Not Applicable]
eArrest.20 - Who First Initiated CPR [NV = Not Applicable]
eArrest.21 - Who First Applied the AED [NV = Not Applicable]
eArrest.22 - Who First Defibrillated the Patient [NV = Not Applicable]
eHistory - Patient History Information
eHistory.01 - Barriers to Patient Care State of Emotional Distress
eHistory.06 - Medication Allergies [PN = No Known Drug Allergy]
eHistory.07 - Environmental/Food Allergies 160244002 - NKA - No known allergies
eHistory.08 - Medical/Surgical History [PN = None Reported]
eHistory.09 - Medical History Obtained From Family
eHistory.CurrentMedsGroup - Group Tag to hold info about patient's medication
eHistory.12 - Current Medications [PN = None Reported]
eHistory.17 - Alcohol/Drug Use Indicators [PN = None Reported]
eHistory.19 - Last Oral Intake October 11, 2023, 11:30:00 GMT-06:00
eNarrative - Call Event Narrative
eNarrative.01 - Patient Care Report Narrative Dispatched to patient having panic attack. Patient feels "like I'm going to die."
eVitals - Patient Vital Sign Information
eVitals.VitalGroup - Group Tag to hold eVitals information
eVitals.01 - Date/Time Vital Signs Taken October 11, 2023, 16:48:10 GMT-06:00
eVitals.02 - Obtained Prior to this Unit's EMS Care No
eVitals.CardiacRhythmGroup - Group Tag to hold information of the type and method used for ECG interpretation associated with the cardiac rhythm.
eVitals.03 - Cardiac Rhythm / Electrocardiography (ECG) [NV = Not Recorded]
eVitals.04 - ECG Type [NV = Not Recorded]
eVitals.05 - Method of ECG Interpretation [NV = Not Recorded]
eVitals.BloodPressureGroup - Group Tag to hold the details of patient's blood pressure.
eVitals.06 - SBP (Systolic Blood Pressure) 122
eVitals.07 - DBP (Diastolic Blood Pressure) 78
eVitals.08 - Method of Blood Pressure Measurement Cuff-Automated
eVitals.HeartRateGroup - Group Tag to hold the details of patient's heart rate.
eVitals.10 - Heart Rate 112
eVitals.11 - Method of Heart Rate Measurement Electronic Monitor (Other)
eVitals.12 - Pulse Oximetry 99
eVitals.14 - Respiratory Rate 62
eVitals.15 - Respiratory Effort Rapid
eVitals.16 - End Tidal Carbon Dioxide (ETCO2) [NV = Not Recorded]
eVitals.18 - Blood Glucose Level 108
eVitals.GlasgowScoreGroup - Group Tag to hold the details of patient's glasgow scale
eVitals.19 - Glasgow Coma Score-Eye 4 - Opens Eyes spontaneously (All Age Groups)
eVitals.20 - Glasgow Coma Score-Verbal 5 - Oriented (>2 Years); Smiles, oriented to sounds, follows objects, interacts
eVitals.21 - Glasgow Coma Score-Motor 6 - Obeys commands (>2Years); Appropriate response to stimulation
eVitals.22 - Glasgow Coma Score-Qualifier Initial GCS has legitimate values without interventions such as intubation and sedation
eVitals.23 - Total Glasgow Coma Score 15
eVitals.TemperatureGroup - Group Tag to hold information about patient's body temperature.
eVitals.24 - Temperature 36.4
eVitals.25 - Temperature Method Oral
eVitals.26 - Level of Responsiveness (AVPU) Alert
eVitals.PainScaleGroup - Group Tag to hold the scale of patient's pain and the type of pain scale used.
eVitals.27 - Pain Scale Score 0
eVitals.28 - Pain Scale Type Numeric (0-10)
eVitals.StrokeScaleGroup - Group Tag to hold the results of patient's stroke scale and the type of stroke pain scale used.
eVitals.29 - Stroke Scale Score [NV = Not Recorded]
eVitals.30 - Stroke Scale Type [NV = Not Recorded]
eVitals.31 - Reperfusion Checklist [NV = Not Recorded]
eVitals.VitalGroup - Group Tag to hold eVitals information
eVitals.01 - Date/Time Vital Signs Taken October 11, 2023, 16:53:26 GMT-06:00
eVitals.02 - Obtained Prior to this Unit's EMS Care No
eVitals.CardiacRhythmGroup - Group Tag to hold information of the type and method used for ECG interpretation associated with the cardiac rhythm.
eVitals.03 - Cardiac Rhythm / Electrocardiography (ECG) [NV = Not Recorded]
eVitals.04 - ECG Type [NV = Not Recorded]
eVitals.05 - Method of ECG Interpretation [NV = Not Recorded]
eVitals.BloodPressureGroup - Group Tag to hold the details of patient's blood pressure.
eVitals.06 - SBP (Systolic Blood Pressure) 112
eVitals.07 - DBP (Diastolic Blood Pressure) 69
eVitals.08 - Method of Blood Pressure Measurement Cuff-Automated
eVitals.HeartRateGroup - Group Tag to hold the details of patient's heart rate.
eVitals.10 - Heart Rate 82
eVitals.11 - Method of Heart Rate Measurement Electronic Monitor (Other)
eVitals.12 - Pulse Oximetry 99
eVitals.14 - Respiratory Rate 22
eVitals.15 - Respiratory Effort Normal
eVitals.16 - End Tidal Carbon Dioxide (ETCO2) [NV = Not Recorded]
eVitals.18 - Blood Glucose Level [NV = Not Recorded]
eVitals.GlasgowScoreGroup - Group Tag to hold the details of patient's glasgow scale
eVitals.19 - Glasgow Coma Score-Eye 4 - Opens Eyes spontaneously (All Age Groups)
eVitals.20 - Glasgow Coma Score-Verbal 5 - Oriented (>2 Years); Smiles, oriented to sounds, follows objects, interacts
eVitals.21 - Glasgow Coma Score-Motor 6 - Obeys commands (>2Years); Appropriate response to stimulation
eVitals.22 - Glasgow Coma Score-Qualifier Initial GCS has legitimate values without interventions such as intubation and sedation
eVitals.23 - Total Glasgow Coma Score 15
eVitals.TemperatureGroup - Group Tag to hold information about patient's body temperature.
eVitals.24 - Temperature 37.8
eVitals.25 - Temperature Method Oral
eVitals.26 - Level of Responsiveness (AVPU) Alert
eVitals.PainScaleGroup - Group Tag to hold the scale of patient's pain and the type of pain scale used.
eVitals.27 - Pain Scale Score 0
eVitals.28 - Pain Scale Type Numeric (0-10)
eVitals.StrokeScaleGroup - Group Tag to hold the results of patient's stroke scale and the type of stroke pain scale used.
eVitals.29 - Stroke Scale Score [NV = Not Recorded]
eVitals.30 - Stroke Scale Type [NV = Not Recorded]
eVitals.31 - Reperfusion Checklist [NV = Not Recorded]
eExam - Patient Exam Information
eExam.01 - Estimated Body Weight in Kilograms 29
eExam.02 - Length Based Tape Measure Orange
eExam.AssessmentGroup - Group Tag to hold assessment information
eExam.03 - Date/Time of Assessment October 11, 2023, 16:50:00 GMT-06:00
eExam.04 - Skin Assessment Clammy
eExam.05 - Head Assessment Normal
eExam.06 - Face Assessment Normal
eExam.07 - Neck Assessment Normal
eExam.09 - Heart Assessment Normal
eExam.AbdomenGroup - Group Tag to hold abdomen assessment findings information
eExam.10 - Abdominal Assessment Finding Location Generalized
eExam.11 - Abdomen Assessment Normal
eExam.12 - Pelvis/Genitourinary Assessment Not Done
eExam.SpineGroup - Group Tag to hold spine assessment findings information
eExam.14 - Back and Spine Assessment Not Done
eExam.ExtremityGroup - Group Tag to hold extremity assessment findings information
eExam.16 - Extremities Assessment Not Done
eExam.EyeGroup - Group Tag to hold eye assessment findings information
eExam.17 - Eye Assessment Finding Location Bilateral
eExam.18 - Eye Assessment PERRL
eExam.LungGroup - Group Tag to hold lung assessment findings information
eExam.22 - Lung Assessment Finding Location Bilateral
eExam.23 - Lung Assessment Normal
eExam.ChestGroup - Group Tag to hold chest assessment findings information
eExam.25 - Chest Assessment Not Done
eExam.19 - Mental Status Assessment State of emotional shock and stress, unspecified
eExam.20 - Neurological Assessment Normal Baseline for Patient
eProtocols - Medical Protocols Information
eProtocols.ProtocolGroup - Group Tag to hold eProtocol information
eProtocols.01 - Protocols Used General-Behavioral/Patient Restraint
eMedications - Intervention Medications Information
eMedications.MedicationGroup - Group Tag to hold eMedication information
eMedications.01 - Date/Time Medication Administered [NV = Not Recorded]
eMedications.02 - Medication Administered Prior to this Unit's EMS Care [NV = Not Recorded]
eMedications.03 - Medication Administered [NV = Not Recorded]
eMedications.04 - Medication Administered Route [NV = Not Recorded]
eMedications.DosageGroup - Group Tag to hold info about the medication dosage administered to the patient
eMedications.05 - Medication Dosage [NV = Not Recorded]
eMedications.06 - Medication Dosage Units [NV = Not Recorded]
eMedications.07 - Response to Medication [NV = Not Recorded]
eMedications.08 - Medication Complication [NV = Not Recorded]
eMedications.10 - Role/Type of Person Administering Medication [NV = Not Recorded]
eProcedures - Intervention Procedures Information
eProcedures.ProcedureGroup - Group Tag to hold eProcedures information
eProcedures.01 - Date/Time Procedure Performed October 11, 2023, 16:48:29 GMT-06:00
eProcedures.02 - Procedure Performed Prior to this Unit's EMS Care No
eProcedures.03 - Procedure 423850004 - Pediatric continuous physical assessment
eProcedures.05 - Number of Procedure Attempts 1
eProcedures.06 - Procedure Successful Yes
eProcedures.07 - Procedure Complication None
eProcedures.08 - Response to Procedure Unchanged
eProcedures.09 - Procedure Crew Members ID 653148 - Sabryna Charlotte Braun
eProcedures.10 - Role/Type of Person Performing the Procedure Paramedic
eDisposition - Patient Disposition Information
eDisposition.DestinationGroup - Group Tag to hold info about the Destination and the Disposition details
eDisposition.01 - Destination/Transferred To, Name [NV = Not Applicable]
eDisposition.02 - Destination/Transferred To, Code [NV = Not Applicable]
eDisposition.05 - Destination State [NV = Not Applicable]
eDisposition.06 - Destination County [NV = Not Applicable]
eDisposition.07 - Destination ZIP Code [NV = Not Applicable]
eDisposition.11 - Number of Patients Transported in this EMS Unit [NV = Not Applicable]
eDisposition.IncidentDispositionGroup - Group Tag to hold info about the incident disposition details
eDisposition.27 - Unit Disposition Patient Contact Made
eDisposition.28 - Patient Evaluation/Care Patient Evaluated and Care Provided
eDisposition.29 - Crew Disposition Initiated and Continued Primary Care
eDisposition.30 - Transport Disposition No Transport
eDisposition.31 - Reason for Refusal/Release Patient/Guardian Indicates Ambulance Transport is Not Necessary
eDisposition.16 - EMS Transport Method [NV = Not Applicable]
eDisposition.17 - Transport Mode from Scene [NV = Not Recorded]
eDisposition.18 - Additional Transport Mode Descriptors [NV = Not Recorded]
eDisposition.19 - Final Patient Acuity Lower Acuity (Green)
eDisposition.20 - Reason for Choosing Destination [NV = Not Applicable]
eDisposition.21 - Type of Destination [NV = Not Applicable]
eDisposition.22 - Hospital In-Patient Destination [NV = Not Applicable]
eDisposition.23 - Hospital Capability [NV = Not Applicable]
eDisposition.HospitalTeamActivationGroup - Group Tag to hold info about the destination team pre-arrival activation
eDisposition.24 - Destination Team Pre-Arrival Alert or Activation [NV = Not Applicable]
eDisposition.25 - Date/Time of Destination Prearrival Alert or Activation [NV = Not Applicable]
eDisposition.26 - Disposition Instructions Provided Problem Specific Instructions Provided
eDisposition.32 - Level of Care Provided per Protocol BLS - All Levels
eOutcome - Patient Outcome Information
eOutcome.01 - Emergency Department Disposition [NV = Not Applicable]
eOutcome.02 - Hospital Disposition [NV = Not Applicable]
eOutcome.EmergencyDepartmentProceduresGroup - Group Tag to hold information about emergency department procedures
eOutcome.09 - Emergency Department Procedures [NV = Not Applicable]
eOutcome.19 - Date/Time Emergency Department Procedure Performed [NV = Not Applicable]
eOutcome.10 - Emergency Department Diagnosis [NV = Not Applicable]
eOutcome.11 - Date/Time of Hospital Admission [NV = Not Applicable]
eOutcome.HospitalProceduresGroup - Group Tag to hold information about hospital procedures
eOutcome.12 - Hospital Procedures [NV = Not Applicable]
eOutcome.20 - Date/Time Hospital Procedure Performed [NV = Not Applicable]
eOutcome.13 - Hospital Diagnosis [NV = Not Applicable]
eOutcome.16 - Date/Time of Hospital Discharge [NV = Not Applicable]
eOutcome.18 - Date/Time of Emergency Department Admission [NV = Not Applicable]
eOther - Other Miscellaneous Information
eOther.08 - Crew Member Completing this Report 653148 - Sabryna Charlotte Braun
eOther.SignatureGroup - Group Tag to hold signature details
eOther.12 - Type of Person Signing EMS Crew Member (Other)
eOther.15 - Signature Status Signed
eOther.19 - Date/Time of Signature October 11, 2023, 17:21:18 GMT-06:00
eOther.20 - Signature Last Name Braun
eOther.21 - Signature First Name Sabryna
eOther.SignatureGroup - Group Tag to hold signature details
eOther.12 - Type of Person Signing EMS Primary Care Provider (for this event)
eOther.15 - Signature Status Signed
eOther.19 - Date/Time of Signature October 11, 2023, 17:22:05 GMT-06:00
eOther.20 - Signature Last Name Renner
eOther.21 - Signature First Name Declan
eOther.SignatureGroup - Group Tag to hold signature details
eOther.12 - Type of Person Signing Patient Representative
eOther.13 - Signature Reason HIPAA acknowledgement/Release
Permission to Treat
Other
eOther.14 - Type Of Patient Representative Guardian
eOther.15 - Signature Status Signed-Not Patient
eOther.16 - Signature File Name release-EMS5.png
eOther.17 - Signature File Type image/png
eOther.18 - Signature Graphic
eOther.19 - Date/Time of Signature October 11, 2023, 16:54:50 GMT-06:00
eOther.20 - Signature Last Name Dietrich
eOther.21 - Signature First Name Barbara