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Data Requirements Across Collection Channels

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Document Overview
This document outlines the required data points for each platform involved in the offline emergency response solution. It ensures consistency across various forms and platforms used by dispatchers, responders, hospitals, and the Signal app.
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1. Dispatcher-Client Form 🖥️

Purpose: To collect necessary information from the caller to initiate an emergency response.
Required Data
Name
Data Type
Source
Notes
1
Date & Time
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2
Caller Name
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3
Caller Phone Number
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4
Patient Name (if different)
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5
Patient Phone Number (if different)
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6
Age
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7
Gender
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8
Insurance Coverage status
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9
Can patient talk?
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10
Patient Location
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11
Patient Count
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12
Case Approval status
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13
Emergency Category
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14
Diagnosis
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15
Time of Call
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16
Incident Description
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17
Immediate Medical Instructions Provided (if any
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18
Dispatch Time
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19
Is Covid Case (Is this communicable? Hazmat Level)
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There are no rows in this table
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Caller Name
Caller Phone Number
Patient Name (if different)
Patient Phone Number (if different)
Age
Gender
Insurance Coverage status
Can patient talk?
Patient Location
Patient Count
Case Approval status
Emergency Category
Diagnosis
Time of Call
Incident Description
Immediate Medical Instructions Provided (if any)
Dispatch Time
Is Covid Case (Is this communicable? Hazmat Level)

First Responder

Time Dispatched
Responder’s Name
Email
Initial Location
Time Arrived

Ambulance Responder

Time Dispatched
First Name
Last Name
Email
Initial Location
Pickup Location
Pickup Time
Dropoff Location
Dropoff Time

Hospital Partner

Time Dispatched
Hospital Name
Staff Email
Phone Number
Time Admitted
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2. Responder Form 🚑

Purpose: To collect detailed incident information and actions taken by the responder on-site.
Required Data:
Responder Name *
Responder Email *
Incident Location *
Arrival Time *
Actions Taken/Procedures Performed
Additional Support Required (if any)
Departure Time from Incident Location
Any Notable Observations
Last Name (autopopulated if the requestor is the patient)
First Name (autopopulated if the requestor is the patient)
Date of birth
ID card number
Gender
Phone number
Country
State
City

Caller information

Relationship to the patient

Diagnoses

Provisional Diagnosis (autopopulated)
Medication History
Ailments
Allergies
Probable Cause
Other comments

Ambulance Medic Assessment: Only for ambulance transporters

Condition of the patient
Care administered
Consumables used
Medic's name
Driver's name

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3. Hospital Form 🏥

Purpose: To document patient handover and initial assessment details upon arrival at the hospital.
Required Data:
Time Dispatched *
Hospital Name *
Staff Email *
Phone Number *
Time Admitted *
Actions Taken/Procedures Performed
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4. Signal Form 📲

Purpose: To capture essential data for the Signal app's offline functionality, ensuring continuity of care and accurate record-keeping.
Required Data:
User ID
User Name
User Phone Number
User Location (GPS coordinates)
Nature of Emergency
Time of Incident
Responder ID
Responder Actions Taken
Hospital Transfer Status (if applicable)
Incident Outcome
User Feedback
Offline Status Indicator
Data Sync Timestamp (when reconnected)
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