SECTION A — Demographics & History ▼
Study ID: PT-0001
Auto-generated
Chief Complaints
Chief Complaint 1 (required)
Chief Complaint 2 optional
Chief Complaint 3 optional
Past Medical History
Medication History (ongoing drugs)
Drug nameDose / frequencyDuration
SECTION B — Vitals ▼
0
Eye (E)
Verbal (V)
Motor (M)
GCS Total: 15 / 15
SECTION C — Examination ▼
General Examination — positive findings only
General examination
Systemic Examination — positive findings only
RS — Respiratory System
CVS — Cardiovascular System
P/A — Per Abdomen
CNS — Central Nervous System
SECTION D — ECG ▼
Blinding reminder
Both doctors must record their interpretation independently before discussing. Do not share findings until both rows are completed.
ECG done
Tap to upload ECG image (PNG / JPG)
SECTION E — Investigations ▼
Troponin
D-dimer
Lactate
CBC (full blood count)
Renal function
Liver function
Blood glucose (FBS/RBS/PPBS)
ABG (Arterial Blood Gas)
Blinding reminderDoctor records ABG values first, then independently writes their interpretation. Interpretation is entered by the treating doctor only.
ABG Values
ABG Interpretation (physician)
Procalcitonin
BNP / NT-proBNP
Chest X-ray (CXR)
Blinding reminder
Physician records CXR interpretation independently before any second review.
Tap to photograph or upload CXR image
Take photo of X-ray on viewing box, or upload digital file
Physician CXR Interpretation
Second Reader / Radiologist (if available)
Ultrasound / FAST
CT scan
SECTION F — Clinical Scores (auto-calculated) ▼
Scores update live as you fill earlier sections.
qSOFA Score
—
Fill vitals
CURB-65
—
Fill age and vitals
HEART Score
—
Fill inputs below
PERC Rule
—
Fill vitals
HEART Score — manual inputs (age and troponin auto-filled)
PERC Rule — tick if present (age, HR, SpO2 auto-filled)
SECTION G — Physician Diagnosis & Treatment Plan ▼
Important — complete this section independently
Record your diagnosis and treatment plan based on your own clinical assessment only. Record your assessment based solely on your clinical examination and investigation results.
Physician Treatment Plan
Physician Treatment Plan — independent clinical decision
SECTION H — Final Diagnosis & Outcome ▼
Final discharge diagnosis
Physician — final diagnosis
System B — suggested final diagnosis
AI-suggested diagnosis will appear here in Research use after physician has independently recorded their diagnosis and treatment above.
System B — Treatment Plan (filled by research coordinator after physician section)
System B Treatment Plan — not visible to treating physician
Comparison (fill after both physician and System B sections complete)
0
Total enrolled
0
Today
0
Pending follow-up
| Study ID | UHID/IPD | Date | Age/Sex | Chief Complaint | Physician Dx | Disposition |
|---|
Data stored on this device. Export CSV regularly as backup.