Description Required? X Justification for this request PHCR PHCR number Number of the PHCR form Date DD/MM/YYYY Car # or Assist Car #. The cars used by the Response IDs paramedics who responded to, or assisted with, the case Patient Information Date of DD/MM/YY Gender Male/female Age Age in years, or months if less than 2 years Transport Information Patient location The address of the scene and the patient’s (from location) destination. The names and codes of hospitals/ diagnostic services are listed. The To’ Destination address ‘Transfer field is left blank if no transfer occurs (transfer to) Times Time paramedics make contact with a patient. Patient contact time Later than scene arrival time if access difficult. Odometer beginning The vehicle odometer reading at the commencement and completion of each case Odometer end Distance travelled The number of kilometres travelled - PHCR Disposition only one is selected by the paramedic A patient was transported from a with no Transported retrieval team in attendance. Includes some patients deceased prior to paramedics’ arrival A patient was treated or transported by a Treatment by retrieval team: Aeromedical (Adults) NETS retrieval team (child to 16 years)
Description Required? X Justification for this request PHCR PHCR number Number of the PHCR form Date DD/MM/YYYY Response IDs Car # or Assist Car #. The cars used by the paramedics who responded to, or assisted with, the case Patient Information Date of DD/MM/YY Gender Male/female Age Age in years, or months if less than 2 years Transport Information Patient location (from location) The address of the scene and the patient’s destination. The names and codes of hospitals/ diagnostic services are listed. The ‘Transfer To’ field is left blank if no transfer occurs Destination address (transfer to) Times Patient contact time Time paramedics make contact with a patient. Later than scene arrival time if access difficult. Odometer beginning The vehicle odometer reading at the commencement and completion of each case Odometer end Distance travelled The number of kilometres travelled PHCR Disposition - only one is selected by the paramedic Transported A patient was transported from a with no retrieval team in attendance. Includes some patients deceased prior to paramedics’ arrival Treatment by retrieval team A patient was treated or transported by a retrieval team: Aeromedical (Adults) NETS (child to 16 years)