Strange EMS Tablet - "Sign Here", but no questions..?

[BackStabbedByInfection]

I am asking as someone who once called an ambulance and had something very strange happen... There was one driver, one male paramedic and he had a tablet he would show me that would have a grey-ish background, one elongated rectangle in the middle, on top of which, it said "Sign here". There were no questions on the tablet, no questions were asked, he verbally stated "Sign here". I wouldn't.., I just stared at it and at him, thinking "What the hell..."... He quickly proceeded to sort of reset the screen as if he wasn't even waiting or expecting me to sign anything. After the screen was reset, he again said "Sign here"- on the screen with "Sign Here" box and no questions... I, again, wouldn't sign anything because there were no questions anywhere...

On the way to the hospital, I could see him with that tablet on the side. He would drag the tablet pen across the screen AS IF he was changing something, but he wasn't. He was just gliding the tablet pen across empty space from left to right, again, AS IF he was changing something or writing.

When we got to the hospital, I was presented the same tablet again and on it was yet another a "Sign here" with a few "Check here" blank places. I think there were a few rows of " If _, then check here__________ " and at the end "Sign here ____". Again, there were no questions, there was no context/content, it was unintelligible, nothing like any form I have seen.

It literally freaked me out, especially because later I came to EMS HQ and asked them what it was all about. They just kept turning their heads and telling me they had no idea what I was talking about... "I am lying to you" was written on their faces... The actual paramedic was unavailable (or "unavailable") and continues to be so...

Was that some kind of sanity test or what? Does it have a name? Can EMS provide their records on me? When I asked my local EMS HQ, all they said they could provide as a report of the incident and it was a one-page, barely any info, no information on any findings, any tests, etc...

 

[CCCSD]

I think you have some issues with the reality of life. What were you taken to the hospital for..?

 

[Jim37F]

It's called a Patient Care Report (PCR.. well technically because it was on a tablet it's an electronic PRC or just ePCR).

Every ambulance provider will have a PCR (whether electronic or paper) filled out for each patient.

As the name implies, it's a report on the patient... i.e. why was the ambulance called, what injuries/illnesses is the patient complaining about?, what other injuries/illnesses did the EMTs/Paramedics find?, what the vital signs are, what treatments they made, as well as the response to those treatments, which hospital they transported to and why (it's not always the closest hospital). As well as other pertinent data such as the patients medical history, allergies, current medications, as well as basic administrative data such as the patients name, address (not just where the call was but their actual address on their ID), phone number, insurance info, times the ambulance crew got the call, got on scene, made patient contact, started transport, arrived at destination, cleared that call and went back into service...

Theres also the Narrative. That's a text box where you write out, in paragraph form, what happened on the call from start to finish (the old paper PCRs often had a space smaller than a flash card for that, so narratives were filled with abbreviations and medical jargon to mean specific things and sometimes didnt include other info if a checkbox elsewhere on the form already covered it.... modern ePCRs that allow you to type out practically an entire novel worth have done some to alleviate that... except most provided tablets dont have a keyboard so typing on them can be a pain, and theres some debate over "how much is too much" to include... you can browse threads here on this site asking about that exact topic...)

On scene at patient side, we're doing the initial assessment. Is this Big Sick or little sick? Critical or not? Gathering vitals (blood pressure, pulse, respiratory rate, lung sounds, oxygen saturation, etc), the story from the patient (and any bystanders or family present) plus their meds if available, to formulate the treatment plan...

Once you're loaded up in the ambulance you're hopefully more or less stabilized, and the medic (in my experience) will typically break out the tablet at this point and start filling out the PCR while enroute to the hospital.

That's probably what the medic was doing here:

On the way to the hospital, I could see him with that tablet on the side. He would drag the tablet pen across the screen AS IF he was changing something, but he wasn't. He was just gliding the tablet pen across empty space from left to right, again, AS IF he was changing something or writing.

If that particular service has privacy screens on their tablets, you'd have to look at it straight on to see the screen, from an angle or just blacks it out to prevent eavesdropping (federal HIPAA and other privacy laws are a Very Big Deal, as in get sued, company goes out of business, people lose their jobs Big Deal. They're taken seriously).

So, the PCR forms part of your medical record, it's also used for billing purposes. Yes, ambulances bill, no they aren't free. Of you have insurance that'll cover the ambulance ride, they still need your info to bill your insurance.

SO.... to the signature. It's you signing NOT that the PCR is accurate (you're not the one filling it out), what you're signing is that you are authorized the ambulance service to treat and transport you (i.e. the medics did not kidnap you against your will) AND to contact your insurance company to bill them direct (much easier than getting the $1200 bill in the mail direct to you). Theres usually some sort of medico-legal paragraph accompanying the signature block stating what the signature is for.

Theres a few reasons why a patient might not sign, including that they're unconscious, too injured to sign, altered mental state, drunk or high, even just plain refused to sign (which it sounds like you would fall under that last category..) is considered a reasonable reason that a patient did not sign.

Since the signature is only authorizing consent for treat, transport, and billing, that's all you really need to see on that screen. Theres no survey for you to fill out, hence no questions for you to answer... the medic or EMT is asking you the questions, and then translating them to medical lingo on the form for you

 

[DesertMedic66]

The odds are the paramedic was attempting to get you to sign documents relating to their HIPAA policy and stating you gave the crew permission to treat and transport you and also allowing the ambulance company to bill your insurance on your behalf.

Refusing to sign that form will create a little bit of a headache for you.

We all have charting to do on calls. Depending on the software it may all be on the same page or it may be on multiple pages/tabs. Charting already takes too much time to complete so I highly doubt a provider would be faking charting.... unless you were a troublesome/annoying patient then maybe. Just because you didn’t see any written or typed information doesn’t mean it is not there.

You should be able to request a copy of the patient care report from the ambulance company. You will likely have to sign more documents to get your information released to you.

Future advise: next time just simply ask “what am I signing for” instead of not saying anything.

 

[Akulahawk]

What you likely were asked to sign, but apparently refused to, is consent to be treated and be transported to the hospital by EMS and then when you got to the hospital, the signature was likely to allow EMS to be able to bill your insurance for the transport as well as you acknowledging (the check boxes and a signature) that they are required to keep certain information protected and private (within specific limits related to billing, sharing with other necessary care providers, etc). Since you apparently refused to sign both, they likely noted that you refused to sign. You may end up being directly billed for the services and you may end up having to submit your EMS bill to your insurance company yourself, all because you refused to sign.

While the chart they created on the tablet is a medical record, it's also a legal one. They will not likely provide you with a copy of that record without you consenting to its release. Even then there may be sensitive portions of that record that they may not be allowed to release to you.

Good luck. It probably would have been better if you'd signed the tablet when asked... and you could have actually asked what you were signing instead of looking blankly at the crew member. Then you likely wouldn't be here asking about this...

 

[Peak]

Also keep in mind that likely one of the nurses in the ED just ended up signing that the crew delivered you to their ED.

We get patients who refuse to sign all the time. It doesn't effect the ambulances ability to pay. In fact they typically will just request your demographic information from the hospital's medical records department later.

Many have tried to game the system, the vast majority have failed.

 

[Akulahawk]

Also keep in mind that likely one of the nurses in the ED just ended up signing that the crew delivered you to their ED.

We get patients who refuse to sign all the time. It doesn't effect the ambulances ability to pay. In fact they typically will just request your demographic information from the hospital's medical records department later.

Many have tried to game the system, the vast majority have failed.

Yep!