EMSForm

EMS Comprehensive Chronological Narrative

Comprehensive EMS documentation template provided by New England Public Safety Headquarters (NEPSHQ). Customize to local agency policy, scope of practice, documentation requirements, and clinical protocols. Review generated documentation before placing it in the patient care record.

By admin · 0 uses · Updated 2026-09-13 17:17:59

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EMS privacy: Do not enter patient names, dates of birth, addresses, phone numbers, medical record numbers, insurance information, or other identifying PHI. Put the official patient record in the authorized ePCR.

Protected generation: your entries stay on this page while DocGen generates the report.

Dispatch / Response

Responding unit / crew

Response mode

Dispatch nature / complaint

Response location

Response delay

Response delay details

Scene safety

Number of patients

Arrival / Initial Contact

Patient location on arrival

Patient position when found

General appearance on first contact

Arrival narrative / scene description

Chronological Event Timeline

Dispatch time

En route time

Arrival time

Patient contact time

Chief Complaint

Chief complaint / reason for EMS

Source of history

Reliability of history

History of Present Illness / Injury

History / events leading to EMS activation

Onset

Provocation / palliation

Provocation / palliation details

Quality / character

Region / location

Radiation

Severity / pain score (0-10)

Time / duration / course

Pertinent negatives

SAMPLE / Relevant History

Additional signs / symptoms

Allergies

Medications

Past medical / surgical history

Last oral intake

Last medications taken

Events preceding illness/injury

Initial assessment time

Primary Assessment

Neurologic Assessment

GCS - Eye opening

GCS - Verbal response

GCS - Motor response

GCS total Formula: gcs_eye+gcs_verbal+gcs_motor

Stroke screen

Stroke screen details

Detailed Physical Assessment

Vital Signs / Diagnostics

Heart rate (bpm)

Blood pressure

Respiratory rate

SpO₂ (%)

EtCO₂ (mmHg)

Temperature

Blood glucose

Cardiac rhythm / monitor interpretation

12-lead ECG interpretation

Additional assessment findings / pertinent negatives

Overall patient condition after assessment

Treatment initiated time

Treatment / Interventions

Medications administered

Procedure / intervention details

Response to treatment

Treatment response details

Medical control

Medical control details

Depart scene time

Destination arrival time

Transfer of care time

Transport / Disposition

Disposition

Movement to stretcher / ambulance

Position during transport

Stretcher restraint / safety

Destination

Destination selection

Transport priority

En route care / reassessment

Condition on arrival

Transfer at destination

Care transferred to

Handoff / transfer-of-care details

Exceptions / Unusual Circumstances

Exception details

Narrative Addendum

Additional chronological details

VisibilityPublic

StatusPublished

LicenseOriginal NEPSHQ template