Medical Necessity

The patient requires ambulance transport due to REPLACE ME (functional limitation or post-dialysis condition).
Transport by POV/wheelchair van was unsafe because REPLACE ME (weakness, fall risk, hypotension, dizziness, SOB, fluid shifts, confusion, inability to ambulate, etc.).

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Dispatch

ProMed Ambulance Company Unit Unit Number was dispatched to Pick-Up Location / Dialysis Facility for a patient requiring return ambulance transportation after a scheduled dialysis treatment.
Unit responded non-emergent with: Crew Members.

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Complaint

Patient completed dialysis today for treatment of end-stage renal disease.
Post-treatment, patient presents with REPLACE ME (weakness, dizziness, hypotension, fatigue, edema, nausea, SOB, cramps, fall risk, difficulty standing, etc.).
Baseline ESRD symptoms include REPLACE ME (continued swelling, abnormal weight changes, anuria, fluid overload) if still present.

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History

Past Medical History: REPLACE ME.
Allergies: REPLACE ME or NKDA.
Dialysis staff report REPLACE ME (post-treatment blood pressure trends, complications, access site condition, difficulty during treatment, fluid removed, any post-dialysis symptoms).

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Assessment

Patient found REPLACE ME (position, appearance).
Mental status: REPLACE ME (A&Ox#, lethargic, confused, fatigued).
Airway/Breathing: REPLACE ME (normal/labored, oxygen needs).
Circulation/Skin: REPLACE ME (edema, perfusion, hypotension signs).
Mobility: Patient is unable to ambulate / unsafe to pivot / high fall risk / weak / post-dialysis hypotensive / unstable due to REPLACE ME.
Vitals: REPLACE ME.
Abnormal findings: REPLACE ME.

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Rx / Treatments

Vitals were obtained, documented, and monitored throughout transport.

Other Procedures Performed (if applicable):

• REPLACE ME (oxygen, glucose check, cardiac monitoring, bleeding control at access site, etc.)

Medications Administered:

• REPLACE ME (drug, dose, route, response)

If none performed:

Patient required continuous monitoring during return transport due to REPLACE ME (post-dialysis weakness, hypotension risk, fluid shifts, edema, SOB, etc.).

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Transport

Patient was transferred from the dialysis treatment chair using REPLACE ME (sheet lift, two-person assist, stand-pivot with support) and secured to the stretcher with all straps and rails.
Patient was transported into the ambulance, loaded, and secured inside.

Unit then went enroute to Destination Name or Address.
Patient was monitored throughout transport and REPLACE ME (remained stable / experienced mild post-treatment symptoms).

Upon arrival, patient was transported into REPLACE ME (facility/home) and assisted safely into bed/chair using REPLACE ME (sheet lift, pivot assist).
Patient care turned over to patient/caregiver/receiving staff.
Unit was then clear and back in service.

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Exceptions

REPLACE ME
(Delays, hazards, environmental barriers, equipment issues, patient behavior, refusal of certain care, etc.)

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END