Patient Care Report

Fields marked * are required. Refusals are documented for liability purposes.

Crew Information

Your Roblox Username *

Your Discord Username

Unit / Callsign *

Call & Patient

Date *

Time *

Patient Roblox Username *

Reason for Call / Chief Complaint *

Capacity Assessment

Mental Status

Patient Has Capacity to Refuse

Refusal Details

Patient's Stated Reason for Refusal *

Warnings / Information Provided to Patient

Explained risks of refusing Advised to call back if worse Offered transport Advised against driving MD notification Supervisor on scene

Witness Roblox Username

Notes

Additional Notes / Narrative

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