COMMUNITY CARE-EMER SELF PRESENTING CARE COORD PLAN – JUNE 12, 2025 @ 14:55



COMMUNITY CARE-EMER SELF PRESENTING CARE COORD PLAN NOTE Has ADDENDA

Emergency Notification Intake

Date Presenting to the Facility: Jun 12,2025

Method of Contact

Submitted to Centralized Call Center

Notification ID: L-20250612211056832

HSRM Referral #:

Community Hospital Name

Hospital: BARSTOW COMMUNITY HOSPITAL

Address

City: Barstow

State: CA

Zip Code

Phone

Community Facility Point of Contact

Name

Phone

Chief complaint: FOUND UNCONSCIOUS

Primary Diagnosis

Disposition

PER OPERATOR PATIENT REMAINS IN THE ED. WILL UPDATE NOTE UPON FURTHER CONTACT.

✍️ Verified Electronically: YOANA VALDEZ ARANA

Healthcare Technician

📅 Signed: 06/12/2025 15:01
⚠️ 06/12/2025 ADDENDUM

Transfer

Transfer to VA

Has the Veteran had a COVID-19 lab test performed?

Unknown

The Veteran is stable for transfer.

Veteran is requesting transfer to VA.

A VA Bed is available

A VA Provider has accepted the Veteran Transfer

Transfer forms have been completed.

Life Sustaining Treatment Orders?

Unknown

Is Isolation needed?

Unknown

Transportation arranged for: Jun 12,2025

Mode of Transportation

Around 1702 received call from Sarah, Barstow CH (760.957.3006) stating veteran

is requesting to transfer to VA-LL. Sarah provided brief background- resp

failure on 4L NC no drips. Completed Repatriation worksheet and printed to ED

charge station. Called ED charge RN (ext 5099) spoke with Marvel, who provided

Dr Witkos ext. Conference call with Dr Allen and Dr Witkos. Dr. Allen stated

veteran has hx of CHF and COPD, veteran’s son went to check up on found him

laying on the floor, possible suicide attempt, 10-11 valium tablets were taken,

EMS arrived veteran was found to hypoxia, 70s-80s while in the ED placed on

BiPAP and weaned to 4L NC, veteran is not endorsing SI, waiting for tox screen

to be resulted. Dr Witkos asked if the veteran intubated, Dr Allen stated

veteran is DNR/DNI. Dr Witkos accepted veteran for transfer. Called was

transfered back to Sarah provided her with accepting physician and number for

report. Sarah stated she will arrange transport and call the transfer center

back when she has a pick up time.

NOD was made of the transfer.

Placed veteran on the repariation tracker.

✍️ Verified Electronically: BREANNA KINSER, RN BSN

STAFF NURSE

📅 Signed: 06/12/2025 17:32
⚠️ 06/12/2025 ADDENDUM

Around 1858 called Barstow CH ED (760.957.3006) spoke with Sarah who stated

transport just picked up veteran. NOD was made made.

✍️ Verified Electronically: BREANNA KINSER, RN BSN

STAFF NURSE

📅 Signed: 06/12/2025 19:01
⚠️ 06/12/2025 ADDENDUM

Around 2023 received call from HOD Lauren stating veteran just arrived and

checking in now.

✍️ Verified Electronically: BREANNA KINSER, RN BSN

STAFF NURSE

📅 Signed: 06/12/2025 20:26