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CHEYENNE REGIONAL MEDICAL CENTER AREA: TITLE: IMPALA: Emergency Medical Treatment and Active Labor Act ADMINISTRATIVE Page 1 of 11 NUMBER: ADMINAD69 ORIGINATOR: Administration APPROVED BY: COO: CNO:
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How to Fill Out Emergency Treatment and Active:

01
Start by providing your personal information, including your full name, date of birth, and contact information. This will ensure that the emergency responders can easily identify you and contact you if needed.
02
Next, provide your medical history, including any chronic conditions, allergies, or medications you are currently taking. This information is crucial for the emergency responders to know in order to provide appropriate and effective treatment.
03
Indicate any emergency contacts you would like to be notified in case of an emergency. Include their full names, phone numbers, and the nature of their relationship to you (e.g., spouse, parent, sibling).
04
Specify any existing medical directives or advanced care plans that you have in place. This includes documents like a Do Not Resuscitate (DNR) order or a Living Will. These directives ensure that your medical preferences are followed in the event of an emergency.
05
Provide a detailed list of your healthcare providers, including primary care physicians, specialists, and any other medical professionals who are involved in your care. This information will help emergency responders reach out to your healthcare providers for additional information or guidance if necessary.
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Lastly, make sure to sign and date the emergency treatment and active form. This signature indicates that you have accurately provided all the necessary information and consent to receive emergency treatment if needed.

Who Needs Emergency Treatment and Active:

01
Individuals with known medical conditions or chronic illnesses should fill out emergency treatment and active forms. This ensures that the emergency responders have access to their medical history and can provide appropriate and timely care.
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Older adults or individuals who are more susceptible to medical emergencies should also have emergency treatment and active forms filled out. This helps facilitate prompt medical attention in case of an emergency.
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People who engage in high-risk activities, such as extreme sports or working in hazardous environments, should also consider filling out emergency treatment and active forms. This will assist emergency responders in providing specialized care or taking necessary precautions based on the individual's specific circumstances.
Please note that it is always advisable to consult with a healthcare professional or legal expert to ensure that your emergency treatment and active forms are properly filled out and meet all legal requirements in your jurisdiction.

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Emergency treatment and active refers to the immediate medical attention and intervention provided to individuals who are in critical condition or experiencing a medical emergency.
Emergency treatment and active is typically filed by healthcare professionals, such as doctors, nurses, or paramedics, who are directly involved in providing the emergency medical care.
The exact process of filling out emergency treatment and active forms may vary depending on the requirements of the specific healthcare facility or jurisdiction. However, it generally involves documenting the details of the emergency medical care provided, including patient information, nature of the emergency, procedures performed, medications administered, and any other relevant information.
The purpose of emergency treatment and active is to record and report the medical interventions and procedures performed during a critical or emergency situation. It serves as a documentation of the immediate medical care provided, ensuring accuracy, accountability, and continuity of care.
The information that must be reported on emergency treatment and active forms typically includes patient demographics, date and time of the emergency, details of the medical emergency or condition, procedures performed, medications administered, vital signs, and any other relevant information necessary for a comprehensive medical record.
The specific deadline to file emergency treatment and active forms in 2023 may vary depending on the regulations and policies of the healthcare facility or jurisdiction. It is recommended to refer to the relevant authorities or guidelines for the accurate deadline for filing.
The penalties for the late filing of emergency treatment and active forms may differ based on local regulations and policies. Common penalties may include fines, reprimands, or potential negative impacts on professional licenses or certifications. It is advisable to review the specific regulations and guidelines governing the filing process to understand the potential penalties for late filing.
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