2020 census: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Patient Information' section. Enter the date of visit, patient’s name, and ZIP code. Ensure you mark the appropriate boxes for sex and ethnicity.
Proceed to the 'Triage' section. Input initial vital signs such as temperature and blood pressure. Mark the urgency of care needed based on your assessment.
In the 'Previous Care' section, indicate if the patient has been seen in this ED recently and provide details about their pain level.
For the 'Reason for Visit', describe the patient's complaints using their own words, ensuring clarity for accurate documentation.
Complete sections on injury/poisoning, provider's diagnosis, diagnostic services, procedures, medications, and visit disposition as applicable.

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