brevaInjury assessment
Encounter
Patient name: [ ] Date of birth: [ ] Date and time of encounter: [ ] Clinician: [ ]
Injury history
Date, time and mechanism: [ ] Site and laterality: [ ] Symptoms, function and relevant prior injury: [ ] Relevant medical history, medications and allergies: [ ]
Evaluation
Vitals measured, with units: [ ] Examination findings including relevant functional and neurovascular assessment: [ ] Imaging or other tests and interpretation: [ ]
Assessment and management
Working diagnosis and differential: [ ] Treatment, immobilization or other intervention actually provided: [ ] Reassessment and response: [ ] Activity guidance discussed: [ ] Referral or transfer decision and rationale: [ ]
Follow-up
Follow-up timing and purpose: [ ] Return precautions discussed: [ ] Patient questions and understanding: [ ]