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Discipline

: Emergency

Sub Discipline

: Emergency

Document Title

: ETD Triage Assessment Note

Assign Zone

Triage Category

ASSESSMENT

Avpu

AlertVerbalPainUnresponsive

Airway

NormalObstructed

Breathing

AdequateNot Adequate

Circulation

NormalCompromise

Mode Of Arrival

Type Of Case

TraumaNon-Trauma

Past Medical/Surgical History

DM

HPT

Asthma

Epilepsy

Heart Disease

Allergy

Others, specify

GENERAL CONDITION

Vital Signs & Other Observations

Posture

History

Physical Examination

LMP Date

Intervention

Immobilisation

C-Collar

Compress

R-I-C-E

Dressing

Investigation

Blood Ketone

Dextrostix

UPT stat

ECG

PEFR

X-Ray

Medication

I.M ATT

Analgesia

Antipyretic

IV Access

Others, specify

SIGNATURES

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