初入院醫療評估, Initial MR

Initial Medical Report, Initial MR

　　初入院時由主治醫師評估患者病況確實填寫，藉以作為未來醫療轉送之依據，當患者重大手術後、病況危急時或轉送在即前均需更新評估。以下為醫療評估時常用問項，各患者仍應視個別病況不同增減其詢問內容。

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1. Is the facility fully adequate to deliver the level of care expected for the patient?
　If no what are your concerns?
2. Principal Diagnosis -
　Relevant Co-morbidities -
3. Date of onset of illness/accident -
4. History of Event (please describe circumstances, if accident) -
5. Past history (all medical problems) and related conditions -
6. Physical Examination: (include main vital signs, temperature and usually O2 saturation); Please give detailed description of clinically relevant areas -
　Pulse: / BP: / Temp: / O2 Sat (Under Air or Oxygen): /
　Platelets: / WBC: / Haemoglobin: / Hematocrit: /
　Clinical Findings -
7. Laboratory and Radiology: (please give results of all relevant studies, eg: blood count, chemistries, ECG, echo, X rays, scans, MRI...) -
8. Treatment: (please describe all major treatment, inc. surgeries, antibiotics, etc); Please note level of care (intensive care, normal ward) -
9. Consultations: (please note main specialty consultations and results) -
10. Course of illness to date (please note main developments) -
11. Current condition of patient: (Mobility, activities of daily life etc.) -
12. Anticipated length of stay -
13. What do you anticipate for disposition of the patient?
　a. Treatment until discharge or ready to travel home:
　b. Immediate evacuation:
　c. Do you anticipate special repatriation assistance?
* If YES to either 13b or 13c, please complete the following:
　Fit To Fly / From (dd/mm/yyyy)
　Escort: □Doctor / □Nurse / □Non-Medical
　Mainliner: □First Class / □Business Class / □Economy Class / □Extra Seat
　□Wheelchair(WCHC // WCHR // WCHS // WCOB) / □Stretcher / □Air Ambulance
　Require Oxygen: / Litre Per Min: / Continuous:
　Re-admission upon arrival: □In-Patient / □Out-Patient / □Home Nurse / □Other:
14. Current recommendations:(please describe any specific recommendations related to above response -

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Wheelchair 類別說明：
WCHC：旅客完全固定在輪椅上，行動需由別人攙扶，需要輪椅運輸上/下飛機客艙。輪椅服務止於客艙。
WCHR：R代表客機梯子，旅客能用客機梯到達自己的座位，但需要輪椅來安排長途旅行。輪椅服務止於客機停機坪。
WCHS：S代表梯子，旅客不能升降梯子，但可自行到達座位上，需要輪椅來安排長途旅行。輪椅服務止於客梯。
WCMP：人力輪椅，是用來送一上旅客的，其重量和尺寸也許是被指定的。
WCOB：飛機艙內的輪椅（由航空公司提供）要求只用在美國運輸之間。
WCBD：電動輪椅，使用乾電池動力。
WCBW：電動輪椅，使用濕電池動力。