1. Request for Patient Disposition following Prehospital Care

Patient outcomes following treatment and transport by EMS to the Emergency Department (ED) can provide valuable information for ongoing quality assurance efforts, including training and education of health care providers. In accordance with the Privacy Rule and the Whatcom County CQI Plan, following the delivery of care and/or transport of a patient, the designated QA officer for any EMS Agency is permitted to receive and use protected health information for health care operations, including competency assurance activities and provider performance evaluation. Release of such information requires that both the requesting agency and the hospital maintain records of disclosures of protected health information for a minimum of three (3) years, with some exceptions, such as written authorization. Furthermore, only the minimum necessary protected health information may be disclosed without the express written authorization by the patient or legally authorized representative.

Electronic communications (i.e. email) that may contain protected or confidential patient information must occur over a secure, encrypted connection. Disclosures must comply with the current HIPAA rule, to include appropriate de-identification. Any unauthorized review, use, disclosure, or distribution of protected health information is prohibited.

This is NOT the tool used to report an unanticipated or adverse event associated with an EMS incident. Please use the EMS/ED Event report form by accessing the link under the Reporting Tab available on the WCEMSTCC website at www.whatcomcountyems.com.

Please include as much information as possible for each question below.