All patients must receive a medical screening exam regardless of their ability to pay.
After triage, the next stop is registration - not very exciting and rarely seen on TV. Here they obtain your vital statistics. You may also provide them with your insurance information, Medicare, Medicaid or HMO card. This step is necessary to develop a medical record so that your medical history, lab tests, X-rays, etc., will all be located on one chart that can be referenced at any time. The bill will also be generated from this information.
If the patient's condition is life-threatening or if the patient arrives by ambulance, this step may be completed later at the bedside.
Now you are brought to the exam room. You promptly throw up in the bathroom, which may be more evidence of appendicitis. You are seen by an emergency-department nurse who obtains more detailed information about you. The nurse gets you settled into a patient gown so that you can be examined properly and perhaps obtains a urine specimen at this time.
Some emergency departments have been subdivided into separate areas to better serve their patients. These separate areas can include a pediatric ER, a chest-pain ER, a fast track (for minor injuries and illnesses), trauma center (usually for severely injured patients) and an observation unit (for patients who do not require hospital admission but do require prolonged treatment or many diagnostic tests).
Once the nurse has finished her tasks, the next visitor is an emergency-medicine physician. He gets a more detailed medical history about your present illness, past medical problems, family history, social history, and a complete review of all your body systems. He then formulates a list of possible causes of your symptoms. This list is called a differential diagnosis. The most likely diagnosis is then determined by the patient's symptoms and physical examination. If this is inadequate to determine the diagnosis, then diagnostic tests are required.