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Methodist Hospital

Patient Tracking Report

Associated Event   
* Patient Name
  Time of arrival
  Date
  Age
* Sex Male     Female    
* Mode of arrival Ambulance    
Private    
Walk In    
Unknow    
OTHER    
  ER Disaster Tag No.
* Condition/Status Critical    
Urgent    
H Stable    
L Stable    
Non Urgent    
Deceased    
* INJURY/COMPLAINT
  If "OTHER," describe:
* Patient Routed To:
  If "OTHER," describe
  Admitted to: (Physician, if known)
  Unit/Bed # (if assigned)
  Isolation needed? YES     NO     Unknown    
* Reported by:
  Comments: