PERKHIDMATAN AMBULAN KEMENTERIAN KESIHATAN BRUNEI DARUSSALAM
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DAILY AMBULANCE REPORT LOG
Email
*
settings
ESN
*
settings
DATE
*
settings
STATION
*
settings
(non operational) support team may include PG support, logistic support or Admin support.
- Choose -
TEAM 1
TEAM 2
SUPPORT TEAM
SHIFT
*
settings
- Choose -
AM
PM
ND
EARLY
LATE
OH
STANDBY SUPPORT
STAFF
*
settings
(Incharge, staff, delta )
MODE OF TRANSPORT
*
settings
- Choose -
LAND
AIR - LAND
SEA - LAND
Ambulance Reg
*
settings
(BGXXXX)
(please state if other vehicle involve or used)
- Choose -
Option 1
Option 2
TIME
RECIEVE
settings
TIME
ON MOBILE
*
settings
TIME
ARRIVE LOCATION
*
settings
TIME
LEAVE LOCATION
*
settings
TIME
ARRIVE DESTINATION
*
settings
PATIENTS DETAILS
Patient's Name
*
settings
GENDER
*
settings
- Choose -
MALE
FEMALE
Date Of Birth
day/month/year (age)
*
settings
BRUHIMS NUMBER
(BNXXXX)
IDENTIFICATION CARD NUMBER
(IC)
or PASSPORT NUMBER
*
settings
Address
*
settings
Mukim
*
settings
DISTRICT
*
settings
- Choose -
BRUNEI MUARA
TUTONG
KUALA BELAIT
TEMBURONG
CASE DETAILS
CATEGORY
*
settings
- Choose -
TRAUMA
MEDICAL
OBGYN
ISO TRAUMA
ISO MEDICAL
ISO OBGYN
T/C TRAUMA
T/C MEDICAL
T/C OBGYN
NEPTS
TYPE OF TRAUMA
settings
- Choose -
MVA (MOTOR VEHICLE ACCIDENT)
GENERAL TRAUMA
N/A
SUB-CATEGORY
*
settings
- Choose -
GENERAL (location to hospital)
HOSPITAL - HOSPITAL
HOSPITAL - CLINIC
CLINIC - HOSPITAL
NEPTS
DISPOSITION
*
settings
- Choose -
AMA
DOA
NEPTS
HOSPITALS
DESTINATIONS
*
settings
- Choose -
ED RIPASH
ED PIHM
ED SSBH
ED PMMH
RIPASH ward
PIHM ward
SSBH ward
PMMH ward
PJSC
JPMC
GJPMC
NEPTS
PRIORITY
*
settings
- Choose -
P 1
P 1 CPR
P 2
P 3
P 3 AMA
P 4 DOA
CHIEF COMPLAINT
*
settings
CASE REPORT
*
settings
(AGE/GENDER,
C/O-
COMPLAINT OF,
H/O-
HISTORY OF,
K/C-
KNOWN CASE [allergies],
O/A-
ON ARRIVAL,
O/E-
ON EXAMINATION,
MX-
MANAGEMENT, DISPOSITION
(-approprite values(VITALSIGN)/findings should be stated properly)
(-state who produce the report
at
the end .....- SNPXXXX
)
EPR (emas patient report) form
settings
Submit
DAILY AMBULANCE REPORT LOG
Click Submit to finish.
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