ACLS Fibrinolytic Time Goal Checklist 📋
Please fill out this checklist to ensure timely fibrinolytic treatment in ACLS protocols.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Patient ID or Medical Record Number
*
Time of Symptom Onset
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Arrival to Emergency Department
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Fibrinolytic Administration
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Fibrinolytic Agent Used
*
Please Select
Alteplase
Reteplase
Tenecteplase
Other
Clinical Notes or Remarks
Documented Timeline and Follow-up Responsibilities
*
I confirm that all timeline entries are accurate and responsibilities are assigned.
Submit
Should be Empty: