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Table 2 The clinical medical form for spectator medical care

From: Spectator medicine at an international mega sports event: Rugby World Cup 2019 in Japan

  Clinical record form: Spectator medical room
Stadium ( )
Spectator med   Date  
room number   Time  
Situation During the game ( ) Location  
in motion ( )
Others ( )
Patient information Name Sex Male / Female
DOB Age ( )years old
Contact No.
Diagnosis / Symptom Gastrointestinal disorder (include vomiting or abdominal pain)
Fever, Cold, Anemia, Headache, Heat illness, Tooth problem Fatigue, Eye problem, Ear problem, Consciousness disorder, Respiratory discomfort, Dizziness, Chest pain, Bruise, Sprain Fracture, Dislocation, Rupture, Wound (stratch, abrasion, cut)
Location of injury ( )
Others ( )
Critical cause
Past history/ allergy
 
Treatment Time ( : )
Medical kit used in Treatment  
Others  
Contact Address  
cell No  
Ambulance (Yes ・ No)
Date: / / Physician's Name: