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Quarterly Report of Mobile Intensive Care Program Mobile App

The Quarterly Report of Mobile Intensive Care Program mobile app allows you to complete your quarterly report using a mobile device. The app covers: System-Wide MICU Information, Vehicle Site Information, Patient Classification, Procedures, Primary Communications with Medical Command, Payment Source, Destinations and Origination of Call. Please Contact GoCanvas is you would like permission to use the GoCanvas Logo.

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  • Mirvac

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Take a peek inside the Quarterly Report of Mobile Intensive Care Program Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    Reports are due to Office of Emergency Medical Services by the 30th of April, July, October and J...

  • Ico dropdown

    Reporting Quarter (Check only one)

  • Ico integer

    Year

  • Ico textbox

    Program Name

  • Ico textbox

    Telephone Number

  • Ico multiline

    Address

  • Ico decimal

    Cost Per Completed ALS Call

  • Ico textbox

    Name of Person Completing Report

  • Ico textbox

    Name of Program Director/Coordinator

  • Ico textbox

    Name of Medical Director

  • Ico integer

    1 MICU Dispatches

  • Ico integer

    2 MICU calls cancelled (Patient not seen)

  • Ico integer

    3 MICU requested and unable to respond (Program Total)

  • Ico integer

    a MICU unavailable, request covered by another MICU Program.

  • Ico integer

    3b MICU unavailable, request for ALS not covered by any MICU Program

  • Ico integer

    4 Patients evaluated by MICU

  • Ico integer

    5 Patients triaged to BLS

  • Ico integer

    6 Patients triaged to BLS and admitted to critical care

  • Ico integer

    7 Patients refusing ALS Treatment

  • Ico integer

    8 Patients treated by MICU as completed ALS calls

  • Ico statictext

    Patient Age Breakdown:

  • Ico integer

    9 0 to 1 Year

  • Ico integer

    10 2 to 8 Years

  • Ico integer

    11 9 to 20 Years

  • Ico integer

    12 21 to 45 Years

  • Ico integer

    13 46 to 65 Years

  • Ico integer

    14 66 Years and Older

  • Ico integer

    15 ALS field pronouncements (By medical command physician)

  • ...and More!

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