Ship-to-Shore Telemedicine Consultation Record
General Information
Date
Time (UTC)
Vessel Name
Call Sign
Position (Lat/Long)
Captain's Name
Medical Officer
Patient Information
Name
Age
Gender
Male
Female
Other
Occupation
Clinical Details
Chief Complaint
History of Present Illness
Past Medical History
Vital Signs
Examination Findings
Investigations/Tests
Telemedicine Consultation
Consultation Details
Provisional Diagnosis
Recommendations/Treatment Plan
Follow-up
Follow-up Date/Time
Shore Doctor/Team Name
Additional Notes