PQRST Program


In our ongoing effort to provide the highest level of emergency medical service care to the residents of the Village of Germantown we are providing the PQRST (Patient Quality Review Sheet for Treatment) Information Sheet and associated database.

During a medical emergency it is important that the emergency crews have accurate information about the patient, additionally any special information like allergies or disabilities.  Some of this information can be pre-entered into our Dispatch Platform so the responders know of the disability or special needs.  For example if a deaf or special needs person lives in the home we would know prior to arrival.  This can expedite patient care and treatment.

How the PQRST System Works

  • Complete the fillable sheet on the computer and print a copy.
  • Place the PQRST Sheet in an accessible location. Some suggested locations are listed below.
  • If calling for the Fire Department Ambulance, have the sheet handy for the responders if practical.
  • Bring the sheet to the hospital with you.
  • You might want to consider making an extra copy and carrying it with you.
  • Remember to update the PQRST Sheet as medication or conditions change.

Finally, if you have a disability or special needs, email the fire department at and we will enter the information into our secure dispatch platform.

Where to Keep the PQRST Sheet

  • On the front of your refrigerator.
  • In your purse or wallet.
  • In a plastic bag in your refrigerator.
  • On the back of your front door.

Click HERE for non-fillable form.  Click HERE for a fillable form.

For additional information, please contact your Germantown Fire Department at (262) 502-4701 ext.1707.

For more information on your Germantown Fire Department

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