Crew gets paged
Pick up ambulance
Pick up patient
Drop off patient
Return to station.
Complete truck duties
Complete IFT Form
Log Into Laptop
Log Into WARDS
Create Patient File
Record Station Time
Use the trip odometer to track mileage to the 10th of a mile.
Medicare / Medicaid requires a decimal point.
DO NOT LOG THE PRIMARY ODOMETER MILEAGE
Reset the trip odometer at the origin facility.
Start mileage should always be 0.0 in WARDS and in the narrative.
Log into WARDS and create your patient file.
Run number format: IFT-MMDDYYYY-Last Name
Pick up location & Address
Pick up time
Destination & Address
Drop off time
1 Set of vitals
Transferred care to:
Who signed the HIPAA
Who signed the PCS
Why was ambulance necessary.
Reason patient was transferred.
Signed PCS Form
Hospital FIN (Face Sheet)
Insurance Info (May be on the face sheet)
Completed WARDS Report
Scan or Store Documents
IFT form submitted by crew
Complete IFT Form
SAMPLE - Narrative Template - Copy/Paste into WARDS
R: (Response) Great Lakes EMS Inc was requested to transport a patient to (Destination Facility).
Unit 3Z** was dispatched to (Origin Facility) for patient pick up on (ROOM FLOOR ER)
EMS Crew: Your Name EMT-? and Partner Name - EMT-?
Mileage at Origin 0.0
C: (Chief Complaint) - Transfer to FACILITY for THESE REASONS indicated in the PCS form.
H (History) - Dispatched to a Health Facility - Hospital for a ** year old MALE/FEMALE requiring Transfer/Interfacility/Palliative Care.
HOSPITAL does not have the specialists to treat this patient, HOSPITAL agreed to accept the patient for immediate interventions.
A (Assessment) - Pain, vitals, GCS, etc
Rx (Rendered Treatment) - Position of comfort, patient monitoring, ---- monitor oxygen, vitals. (etc etc etc what you did)
D (Destination) - The patient was transported Non-Emergent to HOSPITAL. The destination was determined by Patient's Physician's Choice, Regional Specialty Center and special services available at the destination facility.
Patient was transferred to ROOM NUMBER/ER to NURSE/DOCTOR NAME at TIME
Physician Certificate signed by: Nurse / Doctor name - RN, DO, MD, Etc
HIPAA signed by patient PATIENT NAME, witnessed by EMT NAME AND LICENSE LEVEL
Arrival at destination 00:00
Aurora - Oshkosh 855 N Westhaven Dr, Oshkosh, WI 54904
Aurora - Baycare 2845 Greenbrier Rd, Green Bay, WI 54311
Mercy - Oshkosh 500 S Oakwood Rd, Oshkosh, WI 54904
St. Elizabeth 1506 S Oneida St, Appleton, WI 54915
ThedaCare - Neenah 130 2nd St, Neenah, WI 54956
ThedaCare - Appleton 1818 N Meade St, Appleton, WI 54911
ThedaCare - New London 1405 South Mill St, New London, WI 54961
Bellin Hospital 744 S Webster Ave, Green Bay, WI 54301
St Vincent Hospital 835 S Van Buren St, Green Bay, WI 54301
VA Hospital - Waupaca N2692 County Rd QQ, Waupaca, WI 54981
Aurora - GreenBay 2845 Greenbrier Rd, Green Bay, WI 54311
Aurora St. Lukes 2900 W Oklahoma Ave, Milwaukee, WI 53215
Aurora Psychiatric 1220 Dewey Ave, Wauwatosa, WI 53213
VA Hospital (Zablocki) 5000 W National Ave, Milwaukee, WI 53295
Froedtert Hospital 9200 W Wisconsin Ave, Milwaukee, WI 53226
Children's Milwaukee SAME Ambulance Bay / Entrance (8915 W Connell Ct, Milwaukee, WI 53226)
UW - Madison 600 Highland Ave, Madison, WI 53792
Children's Madison SAME ER Doors / Entrance (1675 Highland Ave, Madison, WI 53792)
Physician Certificate Example:
YELLOW fields must be completed for billing.
SECTION I - Signed by the patient.
SECTION I - If minor child: PARENT SIGNS.
SECTION I - EMT Should sign as a witness.
SECTION II - Why patient is not signing.
SECTION II - Legal guardian, spouse or POA. >18
SECTION III - Signed by EMS and Hospital staff.
HIPAA DEFINED CLICK HERE for details.