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: | ||||