Trauma Registry Patient Abstraction Form - healthy arkansas 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with SECTION 1: DEMOGRAPHICS. Fill in the ED Arrival Date, Trauma Band Number, and personal details such as First Name, Last Name, Date of Birth, and Age. Ensure you select the appropriate options for Race and Ethnicity.
3. Proceed to SECTION 2: INJURY. Enter the Injury Date and details about the incident including location and ICD codes. Specify if the injury was work-related and check any protective devices used.
4. In SECTION 3: PRE-HOSPITAL, document EMS Agency information, transport mode, and provider level. Record all relevant dates regarding EMS notifications and arrivals.
5. Continue to SECTION 4: REFERRING FACILITY INFORMATION. If applicable, provide details about inter-facility transfers including hospital names and arrival/discharge dates.
6. Complete SECTION 5: ED Information by indicating how the patient arrived at the ED and documenting trauma team activation details.
7. Fill out subsequent sections (6 to 10) focusing on hospital procedures, diagnoses, outcomes, and financial information as required.

Start using our platform today for free to streamline your form completion process!