Attachment C - 2022 ED Patient Record Form (PRF) Changes

Attachment C

Changes to 2022 NHAMCS Emergency Department Patient Record Form (PRF)

Proposed changes are indicated in RED; variable names are in [ ].

• Modified-Diagnostic Services Ordered or Provided [DIAG_SERVICES]

Enter all Examinations/Screenings, Laboratory tests, Imaging, Procedures, and Health education/counseling ORDERED or PROVIDED.

• NONE

Blood tests:

• Arterial blood gases

• BAC (blood alcohol concentration)

• Basic metabolic panel (BMP)

• Blood culture

• BNP (brain natriuretic peptide)

• BUN/Creatinine

• Cardiac enzymes

• CBC

• Comprehensive metabolic panel (CMP)

• Culture, blood

• Culture, throat

• Culture, urine

• Culture, wound

• Culture, other

• D-dimer

• Electrolytes

• Glucose, serum

• Lactate

• Liver enzymes/Hepatic function panel

• Prothrombin time (PT/PTT/INR)

• Other blood test

Other tests:

• Cardiac monitor

• EKG/ECG

• HIV test

• Influenza test

• Pregnancy/HCG test

• Toxicology screen

• Urinalysis (UA) or urine dipstick

• Other test/service

Imaging:

• X-ray

• CT scan
  - Abdomen/Pelvis
  - Chest
  - Head
  - Other
  
  

Was CT ordered/provided with intravenous (IV) contrast?
- Yes
- No
- Unknown

• MRI
  Was MRI ordered/provided with intravenous (IV) contrast
  (also written as “with gadolinium” or “with gado”)?
  - Yes
  - No
  - Unknown
  
  

• Ultrasound
  Who performed the ultrasound?
  - Emergency physician
  - Other provider
  
  

• Other imaging

COVID-19 tests:

• Coronavirus disease [COVID-19] test

• Coronavirus disease [COVID-19] antibody test

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