Posted: June 1st, 2015

Topic: case card format

Case card- assignment
The aim of this assignment is to bring together many of the assessment principles that have been
introduced in this topic. This is an opportunity for you to consider how the material you have learned
has influenced your practice.
You are required to submit a case card (patient report form). You are to perform an assessment on
someone you know (friend, family member etc) and record your findings on your newly designed
report.
Compile in MS word or convert to JPEG if needed.
Directions:
Assume that the person you are assessing has a complaint of “a conscious collapse after feeling
generally unwell”.
The rest of the history, detail, investigations/ findings are at your discretion- you have creative license
here!
No word count, however you have a maximum of 20 lines of text you may use (similar to a standard
case card- south Australia Ambulance Service)
No references are required
You may follow the existing case card templates/formats of any service or design your own
Numerical observations fields are not required (BP, ECG), but you may wish to refer to pulse, resps
and GCS!
Please provide a single differential diagnosis (made up)
Example
Presenting
Complaint
Allergies /
Sensitivites
Communicable
Diseases
PHx- Past Medical History
Med’n- Medication
Hx-History
O/A – On Arrival
O/E- On Examination
P – Provisional Diagnosis
Time /Pulse/ Resp/ // Sp02/ GCS
E V M/ GCS Total
/ Pain10
Treatment / event / drug / observation
Dose/ Units / Route