Pan-Flu Tracking Log: Boulder County

Electronic CCR (Emergency Portion)

Facilitating Critical Inter-Hospital Emergency Data Exchange

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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: