Patient Contacts Tracker
What is your name?
*
Please Select
Booker
Carroll
Dowling
Egan
Frederickson
Hamilton
Hoffman
Markey
Mechlin
Obando
OBryan
Olds
Patterson
Reid
Reitz
Rivas
Romano
Sartini
Thornton
Enter the clinical date
*
-
Month
-
Day
Year
Date Picker Icon
Where did you encounter the patient?
*
Hospital
Medic unit
Classroom
AFRA
No patients
Which unit were you on?
*
ED
Pediatrics
Geriatrics
L & D
Psychiatric
OR
Cath Lab
What was the age of the patient? (You may select more than one option if you are entering multiple patients)
*
Newborn (birth-1 mo)
Infant (2 mo-1 year)
Toddler (1 year-2)
Preschooler (3-5)
School Age (6-12)
Adolescent (13-18)
Adult (19-60)
Geriatric (60+)
Newborn - Select the number of patients you made contact with for the respective chief complaint.
Number of Patient
Syncope
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Endocrine
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Chest Pain
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Respiratory
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Reproductive
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Genitourinary
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Integumentary
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Cardiovascular
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Gastrointestinal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Musculoskeletal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Immune / Lymph
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Altered Mental Status
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Nervous (include psych)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Infant - Select the number of patients you made contact with for the respective chief complaint.
Number of Patients
Syncope
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Endocrine
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Chest Pain
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Respiratory
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Reproductive
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Genitourinary
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Integumentary
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Cardiovascular
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Gastrointestinal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Musculoskeletal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Immune / Lymph
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Altered Mental Status
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Nervous (include psych)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Toddler - Select the number of patients you made contact with for the respective chief complaint.
Number of Patients
Syncope
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Endocrine
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Chest Pain
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Respiratory
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Reproductive
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Genitourinary
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Integumentary
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Cardiovascular
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Gastrointestinal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Musculoskeletal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Immune / Lymph
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Altered Mental Status
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Nervous (include psych)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Preschooler - Select the number of patients you made contact with for the respective chief complaint.
Number of Patients
Syncope
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Endocrine
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Chest Pain
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Respiratory
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Reproductive
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Genitourinary
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Integumentary
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Cardiovascular
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Gastrointestinal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Musculoskeletal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Immune / Lymph
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Altered Mental Status
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Nervous (include psych)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
School age - Select the number of patients you made contact with for the respective chief complaint.
Number of Patients
Syncope
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Endocrine
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Chest Pain
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Respiratory
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Reproductive
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Genitourinary
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Integumentary
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Cardiovascular
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Gastrointestinal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Musculoskeletal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Immune / Lymph
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Altered Mental Status
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Nervous (include psych)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Adolescent - Select the number of patients you made contact with for the respective chief complaint.
Number of Patients
Syncope
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Endocrine
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Chest Pain
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Respiratory
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Reproductive
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Genitourinary
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Integumentary
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Cardiovascular
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Gastrointestinal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Musculoskeletal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Immune / Lymph
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Altered Mental Status
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Nervous (include psych)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Adult - Select the number of patients you made contact with for the respective chief complaint.
Number of Patients
Syncope
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Endocrine
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Chest Pain
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Respiratory
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Reproductive
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Genitourinary
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Integumentary
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Cardiovascular
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Gastrointestinal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Musculoskeletal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Immune / Lymph
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Altered Mental Status
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Nervous (include psych)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Geriatric - Select the number of patients you made contact with for the respective chief complaint.
Number of Patients
Syncope
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Endocrine
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Chest Pain
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Respiratory
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Reproductive
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Genitourinary
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Integumentary
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Cardiovascular
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Gastrointestinal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Musculoskeletal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Immune / Lymph
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Altered Mental Status
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Nervous (include psych)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Please use the space below to provide any additional information you wish to share with Academy staff.
Submit
Should be Empty: