EMS Forms
Each form below is available in PDF format.
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Patient Forms:
- Patient Request for Access to Protected Health Information
- Request for Amendment of Protected Health Information
- Procedure for Filing Complaints About Privacy Practices
- Notice of Privacy Practices
Education Forms:
- “My Fall Free” Injury Prevention Self-evaluation Form.
Public Access:
Agency Forms:
- EMS Phone and Address 2011
- Ltr of Narc Compliance
- EMS Observer Ride Along Form
- Physician Certification for Non Emergency Ambulance Transfers
- Exposure Report Form
- Drug & Alcohol Test Informed Consent Form
- Hepatitis B Release Form
- Vehicle Accident or Injury Report
- EMS Incident Reporting Form
- Injury Checklist Protocol
- Reimbursement-Stipend Form
- 2011 Stipend Form
- 2011 Reimbursement Form
- http://sanjuanems.org/uncategorized/professional-cpr-resources High Density CPR Training Forms
- Record of Compliance for Narcotics Reporting
- Monthly Financial Review
INSURANCE POLICIES:
- Life Insurance and Disability 2012
- VFIS 2012 Umbrella
- VFIS 2012 Commercial Auto
- VFIS 2012 Coverages
- HRA Reimbursement Claim Form
SOLO:
EMT/OTEP:
- **2011 UPDATED** EMT Skills Sheets (Appendix H)
- OTEP 2007-2010
- OTEP 2011-2013
- Rookie Book 2012
Equipment and Training:
- Verification of Medical Device Training Form
- LifePak Setup
- IV Pack Setup
- Extrication Kit
- Extrication Kit Compartment
Paramedic/CE:
- Paramedic Re-certification Requirements
- Paramedic CE Tracking Forms
- Intubation Training Record
- Paramedic Rig Checkout Form
- Paramedic Field Evaluation Form
- Renewing your FP-C
- FP-C CE Log
- Paramedic Intubation Record
Annual Evaluation Forms:
- 2011 EMS Evaluation Mission and Core Values
- 2011 ANNUAL PERFORMANCE APPRAISAL
- 2011 360 Peer Customer Feedback Form
NIMS:
Payroll and Benefits:
Navigation for password protected areas:
EMS FORMS * EMS POLICIES * EMS PROTOCOLS * EMS JOBS * PERSONNEL RESOURCES
