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Electronic CCR (Emergency Portion)

Facilitating Critical Inter-Hospital Emergency Data Exchange

BOULDER COUNTY INFORMATION CONTINUUM OF CARE RECORD

Pandemic Flu Emergency Portion

Purpose: This record is intended to foster and improve continuity of patient care, improve patient safety, increase patients’ roles in managing their health and ensure at least a minimum standards of health information is available for all care providers.

Select Your Primary Boulder County Hospital:   

Pan Flu Vaccination Priority:


Pan Flu Vaccination Priority:


Vaccinated:

Checked Means Vaccinated:    Date:
Advanced Directives:
Organ Donation Status:
Medications:
Critical Medical Problems:
EKG Click For Latest EKG
Next of Kin / Surrogate:
Primary Care Physician:
Miscellaneous Emergency Data:
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