Form nhamcs 100 care printable 2025

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4.8 out of 5

83 votes

The document is a patient record form for the National Hospital Ambulatory Medical Care Survey (NHAMCS) specifically for emergency department visits in 2007. It includes sections for patient information, triage details, previous care, reasons for visit, injury or poisoning details, provider diagnoses, diagnostic services, procedures performed, medications administered, visit disposition, and hospital admission information. The form emphasizes confidentiality and is used to collect data on emergency medical care.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Patient Information' section. Enter the patient's name, date of visit, date of birth, and ZIP code. Ensure that you mark (X) in the appropriate boxes for sex and ethnicity.
Proceed to the 'Triage' section. Input initial vital signs such as temperature, heart rate, and blood pressure. Indicate how quickly the patient should be seen using the provided options.
In the 'Previous Care' section, answer whether the patient has been seen in this ED within the last 72 hours and provide details on their pain level.
Fill out the 'Reason for Visit' by describing the patient's complaints in their own words. Mark any relevant episodes of care.
Complete sections on injury/poisoning/adverse effects, provider's diagnosis, diagnostic services, procedures, medications & immunizations as applicable.
Finally, review all entries for accuracy before saving or exporting your completed form.

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Versions	Form popularity	Fillable & printable
2006	4.8 Satisfied (83 Votes)
2005	4 Satisfied (20 Votes)

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