Emergency medical analysis form with detachable patient identification piece and method of using same

• US 20050285385A1
• Filed: 06/28/2004
• Published: 12/29/2005
• Est. Priority Date: 06/28/2004
• Status: Abandoned Application

• Current Assignee: Ward Kraft
• Original Assignee: Ward Kraft
• Inventors: Thompson, Mark D., Bova, Antonio V.
• Application Number:
  US10/878,767
• Publication Number:
  US 20050285385A1
• Time in Patent Office: Days
• US Class Current: 283/75
• CPC Class Codes: B42D 15/00 Printed matter of special format or style not otherwise provided for

Abstract

The present invention is a combination business form having first and second parts that are separable from one another one of the parts is used for recording information acquired in an exigent or emergency medical situation and the other part is used to provide at least one detachable patient identification piece such as a wristband, tag or the like. The business form assembly is intended for use by medical triage or paramedic personnel in providing an initial medical diagnosis of a patient and for identifying the patient for subsequent treatment and transporting to a care facility. The form assembly may be provided in a kit arrangement and include additional components such as a sample collection piece, collection tool and the like. In addition, each of the components may be provided with matching indicia so as to facilitate the tracking of the patient or individual during transport, treatment and handling.

Claims

1. An emergency medical treatment combination form, comprising;

a substantially planar substrate having first and second separable portions;

said first portion adapted to receive patient information, said first portion having a first face and a second face, said first face having a number of patient information recordation areas relating to a condition of a patient, and said first portion having top and bottom ends and first and second sides; and

said second portion having top and bottom ends and first and second sides, said second portion is connected to said first portion along one of said ends or sides, said second portion having an outer section and an inner section, said inner section is separable from said outer section in order to create a patient identification piece.

2. An emergency medical treatment combination form as recited in claim 1, wherein said inner section forms a wrist band having first and second ends and that has at least one exposed adhesive part to connect said ends together about a patient'"'"'s wrist, arm, leg or ankle.

3. An emergency medical treatment combination form as recited in claim 1, wherein said first and second portion are constructed from a material that is tear and water resistant.

4. An emergency medical treatment combination form as recited in claim 1, wherein one of said first and second portions is provided with at least one removable pressure sensitive label.

5. An emergency medical treatment combination form as recited in claim 1, wherein said second portion is provided with a second patient identification piece.

6. An emergency medical treatment combination form as recited in claim 5, wherein said second identification piece is selected from a group including a tag, label, button, hang tag, card and combinations thereof.

7. An emergency medical treatment combination form as recited in claim 1, wherein said first portion has a dimension including a longitudinal direction and a transverse direction and said second portion has a dimension including a longitudinal direction and a transverse direction one of which is less than said longitudinal direction and transverse direction of said dimension of said first portion.

8. An emergency medical treatment combination form as recited in claim 1, wherein said form further includes a detachable specimen collection component.

9. An emergency medical treatment combination form as recited in claim 1, wherein the patient identification piece and first part are provided with matching indicia to facilitate tracking and matching.

10. A triage business form, comprising;

a first part having front and back faces, first and second sides and top and bottom ends, said first part having a first dimension including a longitudinal direction and transverse direction and including at least one area for immediate diagnosis of a patient and another area for providing treatment information;

a second part having front and back faces, first and second sides and top and bottom ends, said second part is connected to said first part alone one of said sides or ends, said second part having a second dimension including a longitudinal direction and a transverse direction, said second dimension is less than said first dimension in one of said longitudinal or transverse directions and said second part including a detachable patient identification band; and

each of said first and second parts is provided with matching indicia for tracking and matching of information.

11. A triage business form as recited in claim 10, wherein said second dimension of said second part is less than said first dimension along said transverse direction.

12. A triage business form as recited in claim 10, wherein said second dimension of said second part is less than said first dimension along said longitudinal direction.

13. A triage business form as recited in claim 10, wherein said first and second parts are formed from a tear resistant material.

14. A triage business form as recited in claim 10, wherein said first part includes at least one removable pressure sensitive label.

15. A triage business form as recited in claim 10, wherein said second part includes a second detachable patient identification piece selected from a group including tags, labels, hang tags, buttons and combinations thereof.

16. A triage business form as recited in claim 10, wherein said triage business form includes a detachable specimen collection component.

17. A triage business form as recited in claim 10, wherein said patient identification band is provided with a fastening element selected.

18. A triage tag and specimen collection piece kit, comprising;

a triage tag including first and second parts, one of said parts including at least one removable patient identification pieces selected from a group including bands, tags, labels, buttons and combinations thereof, said first part including emergency patient diagnosis information areas;

a specimen collection piece including a relatively rigid portion and an absorbent portion, said absorbent portion for collecting a biological specimen; and

a container for holding at least one triage tag and said specimen collection piece.

19. A kit as recited in claim 18, wherein said kit further includes a specimen collector selected from a group including swabs, syringes, wipes, cups and combinations thereof.

20. A kit as recited in claim 18, wherein each of said triage tag, patient identification piece and collection piece is provided with matching indicia to enable tracking and matching of information.

21. A kit as recited in claim 18, wherein said container is a plastic bag.

22. A method of using a triage form and patient identification band, comprising the steps of;

obtaining a triage form and patient identification band, said form having first and second parts with said first part containing at least first and second distinct areas for retaining patient information and said second part having a detachable band;

recording preliminary condition on said first area of said first part of said triage form;

describing additional details relating to a patient on said second distinct area of said first part of said triage form;

removing said patient identification band from said second part and inserting patient information on said band and applying said band to the patient;

separating at least one additional removable patient identification piece from said form;

transporting the patient with said form, band and at least one additional patient identification piece to a treatment location; and

matching information contained on said band and at least said form for confirmation prior to providing additional treatment.

23. A method as recited in claim 22, including a further step of collecting a biological specimen with a specimen collection piece prior to the step of transporting the patient.