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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the patient's home address or duty station in the designated fields, including street address, city, state, and zip code.
- Fill in the arrival time and provide the duty/local phone number along with the home phone number.
- Indicate military status and whether there is third-party insurance by selecting 'Yes' or 'No'.
- Complete the medical history section by noting any current medications and allergies.
- Document vital signs such as pulse, temperature, and blood pressure in their respective fields.
- Finally, ensure that all required signatures are provided at the end of the form for validation.
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