Run Sheet / Pt Refusal

[stever]

I've been tasked with re-designing our run sheets / pt refusal forms. Currently we have the run sheets on the front of a 2-part carbonless form with the pt refusal form on the back. Unfortunately this doesn't work very well because when the pt signs the refusal (on the reverse side of the run sheet) the signature does go to both pages, it just shows on the first page.

I'm curious what other agencies do. Do you have 2 separate forms? Are you using something other than a carbonless form?

Please advise. Hopefully there are other feasible options out there.

Stever

PS - First post!!

[smurfe]

Our refusal is on the back of the front page, ours are 2 page carbonless also and has a scan page on the rear. We have no problem with the signature marking the other page, but if we did, it would be no big deal as that page is trashed anyway (Hospital copy).

If you want, you can PM or email me your address and I will send you one of ours run reports.

Smurfe :D

[stever]

Thanks for your response Steven. I sent you a private email. Hopefully your solution will be feasible for our district.

Anyone else have other solutions?

Stever

[IAMedic]

I just emailed you our run report.

[hageremtp]

I could snail mail you a copy of our trip ticket. Its the legal sized sheet of paper. Everything is on the front of the page, nothing on the back! If your intrested in this let me know, I might be able to scan in a copy too.........I can try next time I work!

[MintShakes]

Ours is 2 sided carbonless and if we do want both pages with a signature, we just have the pt. sign twice :) Once on the yellow, once on the white. Usually we just have them sign on the white (our copy) since the hospital copy isn't going to any hospital

[smurfe]

Whoops, forgot to tell ya. I snail mailed ya one of ours a couple days ago

Smurfe :D

[stever]

IAMedic – Got your email. Thanks. What a great idea to have the HIPAA signature on the run report. I think we’ll incorporate that in to ours. Not sure if we want to go to a legal size form, maybe we could squish it all on a regular letter size. Others in my district think we’ll need a little more information for the refusal.

Hageremtp – If you can snail mail me a copy I would really appreciate it. I going to incorporate everyone’s forms and change ours around a little. I’ll email you my address.

MintShakes – Sounds like your form is similar to ours. What we are trying to do is have the pt sign once and leave them with a copy. We’ll see if it works out.

Smurfe – Thanks for snail mailing me a copy!!

Thanks everyone for helping me out. What a great community we have going here!

Stever

[smurfe]

What a great idea to have the HIPAA signature on the run report.

The one I mailed you doesn't have the HIPAA info on it, but our new ones will. Just got an email today that when I order new run forms, it will have the HIPAA info on it

Smurfe :D