Indication of whether the form needs review by anyone. An indication if the patient may meet the entry criteria for a injury or illness specific registry The personal protective equipment which was used by EMS personnel during this EMS patient contact. Suspicion of the listed multi-casualty or domestic terrorism causes. Indication of unprotected contact with blood or body fluids The type of exposure or unprotected contact with blood or body fluids The EMS personnel who was/were exposed to unprotected contact with blood or body fluids The presence of any condition which is reportable based on federal or state regulations. A customizable field to be used by local agencies for additional documentation or research. A customizable field to be used by local agencies for additional documentation or research. Title for customizable field to be used by local agencies for additional documentation or research. The statewide assigned ID number of the EMS crew member which completed this patient care report