Sync template from atomicqms-style deployment

Forms/Intake-Forms/FRM-UC-001-Triage-Assessment.md

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+# Urgent Care Triage Assessment
+
+| Form ID | FRM-UC-001 | Revision | 1.0 |
+|---------|-------------|----------|-----|
+
+---
+
+## Patient Information
+
+| Field | Entry |
+|-------|-------|
+| Patient Name | |
+| MRN | |
+| Date of Birth | |
+| Age | |
+| Sex | ☐ Male ☐ Female |
+| Date | |
+| Time of Arrival | |
+| Time of Triage | |
+
+---
+
+## Chief Complaint
+
+*In patient's own words:*
+
+**Duration of Symptoms:**
+
+---
+
+## Vital Signs
+
+| Parameter | Value | Normal? |
+|-----------|-------|---------|
+| Temperature | °F / °C | ☐ Yes ☐ No |
+| Heart Rate | bpm | ☐ Yes ☐ No |
+| Respiratory Rate | /min | ☐ Yes ☐ No |
+| Blood Pressure | / mmHg | ☐ Yes ☐ No |
+| SpO2 | % on ☐ RA ☐ O2 ___L | ☐ Yes ☐ No |
+| Pain Score | /10 | |
+| Weight | kg / lbs | |
+| Blood Glucose (if indicated) | mg/dL | ☐ N/A |
+
+---
+
+## Allergies
+
+☐ No Known Drug Allergies (NKDA)
+☐ No Known Allergies (NKA)
+
+| Allergen | Type | Reaction |
+|----------|------|----------|
+| | ☐ Drug ☐ Food ☐ Environmental | |
+| | ☐ Drug ☐ Food ☐ Environmental | |
+| | ☐ Drug ☐ Food ☐ Environmental | |
+
+---
+
+## Current Medications
+
+| Medication | Dose | Frequency |
+|------------|------|-----------|
+| | | |
+| | | |
+| | | |
+| | | |
+
+---
+
+## Brief Medical History
+
+☐ None significant
+
+| Condition | Yes | Condition | Yes |
+|-----------|-----|-----------|-----|
+| Diabetes | ☐ | Heart Disease | ☐ |
+| Hypertension | ☐ | Lung Disease/Asthma | ☐ |
+| Kidney Disease | ☐ | Liver Disease | ☐ |
+| Blood Clots/DVT | ☐ | Cancer | ☐ |
+| Seizures | ☐ | Immunocompromised | ☐ |
+| Pregnancy | ☐ (LMP: _______) | Other: | ☐ |
+
+---
+
+## History of Present Illness
+
+### OPQRST
+
+| Element | Response |
+|---------|----------|
+| **O**nset: When did this start? | |
+| **P**rovocation: What makes it better/worse? | |
+| **Q**uality: Describe the symptom | |
+| **R**adiation: Does it travel anywhere? | |
+| **S**everity: How bad is it (0-10)? | |
+| **T**iming: Constant or comes and goes? | |
+
+### Associated Symptoms
+
+| Symptom | Present | Symptom | Present |
+|---------|---------|---------|---------|
+| Fever/Chills | ☐ | Nausea/Vomiting | ☐ |
+| Headache | ☐ | Diarrhea | ☐ |
+| Shortness of Breath | ☐ | Urinary Symptoms | ☐ |
+| Chest Pain | ☐ | Rash | ☐ |
+| Dizziness | ☐ | Weakness | ☐ |
+| Cough | ☐ | Vision Changes | ☐ |
+| Sore Throat | ☐ | Numbness/Tingling | ☐ |
+
+---
+
+## Quick Look Assessment
+
+### General Appearance
+
+| Observation | Finding |
+|-------------|---------|
+| Alert and oriented | ☐ Yes ☐ No |
+| In acute distress | ☐ Yes ☐ No |
+| Skin color | ☐ Normal ☐ Pale ☐ Flushed ☐ Cyanotic |
+| Respiratory effort | ☐ Normal ☐ Labored |
+| Ambulation | ☐ Independent ☐ Assisted ☐ Wheelchair ☐ Stretcher |
+| Obvious injuries | ☐ None ☐ Present: _______ |
+
+---
+
+## Screening Questions
+
+### Safety Screens
+
+| Question | Response |
+|----------|----------|
+| Fall in past 24 hours? | ☐ Yes ☐ No |
+| Head injury? | ☐ Yes ☐ No |
+| Loss of consciousness? | ☐ Yes ☐ No |
+| Recent surgery? | ☐ Yes (When: _______) ☐ No |
+| Recent travel? | ☐ Yes (Where: _______) ☐ No |
+| Exposure to COVID-19/illness? | ☐ Yes ☐ No |
+
+### For Women of Childbearing Age
+
+| Question | Response |
+|----------|----------|
+| Could you be pregnant? | ☐ Yes ☐ No ☐ N/A |
+| Last menstrual period | |
+| Currently breastfeeding? | ☐ Yes ☐ No ☐ N/A |
+
+---
+
+## Red Flag Assessment
+
+**Check if ANY present (requires immediate provider notification):**
+
+| Red Flag | Present |
+|----------|---------|
+| Chest pain/pressure | ☐ |
+| Difficulty breathing at rest | ☐ |
+| SpO2 <92% | ☐ |
+| Severe headache (worst of life) | ☐ |
+| Sudden vision loss | ☐ |
+| Sudden weakness/numbness | ☐ |
+| Speech difficulty | ☐ |
+| Facial droop | ☐ |
+| Uncontrolled bleeding | ☐ |
+| Altered mental status | ☐ |
+| Syncope | ☐ |
+| Anaphylaxis symptoms | ☐ |
+| Suicidal/homicidal ideation | ☐ |
+
+**If ANY checked → Immediate provider evaluation and consider ED transfer**
+
+---
+
+## Acuity Level Assigned
+
+☐ **Level 1 - Emergent** (ED Transfer Required)
+   → Provider/911 notified: Time _______ Name _______
+
+☐ **Level 2 - Urgent** (Provider within 15 min)
+   → Provider notified: Time _______
+
+☐ **Level 3 - Semi-Urgent** (Provider within 30 min)
+
+☐ **Level 4 - Non-Urgent** (Provider within 60 min)
+
+☐ **Level 5 - Redirect** (Outside UC scope)
+   → Redirected to: _______
+
+---
+
+## Interventions Initiated
+
+| Intervention | Ordered | Completed |
+|--------------|---------|-----------|
+| Ice pack | ☐ | ☐ |
+| Elevation | ☐ | ☐ |
+| Wound care | ☐ | ☐ |
+| POC glucose | ☐ | ☐ |
+| POC UA | ☐ | ☐ |
+| POC strep | ☐ | ☐ |
+| POC flu/COVID | ☐ | ☐ |
+| ECG | ☐ | ☐ |
+| Other: | ☐ | ☐ |
+
+---
+
+## Pain Assessment
+
+| Field | Entry |
+|-------|-------|
+| Location | |
+| Quality | ☐ Sharp ☐ Dull ☐ Aching ☐ Burning ☐ Throbbing |
+| Intensity (0-10) | /10 |
+| Onset | ☐ Sudden ☐ Gradual |
+| Duration | |
+| What relieves it? | |
+| What worsens it? | |
+| Previous episodes? | ☐ Yes ☐ No |
+
+---
+
+## Injury Details (if applicable)
+
+| Field | Entry |
+|-------|-------|
+| Mechanism of Injury | |
+| Time of Injury | |
+| Location of Injury | |
+| Tetanus status | ☐ Up to date ☐ Needs update ☐ Unknown |
+| Work-related? | ☐ Yes ☐ No |
+
+---
+
+## Additional Notes
+
+---
+
+## Re-Triage (if waiting time extended)
+
+| Time | Vital Signs | Condition Changed? | New Acuity | Initials |
+|------|-------------|-------------------|------------|----------|
+| | | ☐ Yes ☐ No | | |
+| | | ☐ Yes ☐ No | | |
+| | | ☐ Yes ☐ No | | |
+
+---
+
+## Triage Nurse/MA Signature
+
+| Field | Entry |
+|-------|-------|
+| Name | |
+| Credentials | |
+| Signature | |
+| Date | |
+| Time | |
+
+---
+
+## Provider Acknowledgment
+
+| Field | Entry |
+|-------|-------|
+| Provider notified at | (time) |
+| Provider seen at | (time) |
+| Provider Signature | |
+
+---
+
+*Form FRM-UC-001 Rev 1.0 - Urgent Care Triage Assessment*