EMS Agency Electronic Patient Care Reporting (ePCRs)

Question Title

1. Please give us your name and agency. (Required.)

Name:

Title:

Agency:

County:

Email Address:

Phone Number:

Question Title

2. Does your agency use electronic or paper EMS reports ? (Required.)

Electronic

Paper

Add comments if you wish.

Question Title

3. If you use an electronic EMS runsheet, which electronic EMS reporting system do you use? If solely using paper runsheets, click none. (Required.)

Alert Public Safety Solutions

AmbuPro by OCI Software

Cisco

Clayton IDS

Emergency Reporting

Emergitech

EMS Charts

ESO

Firehouse

FirePrograms Software

ImageTrend

Medical Claims Assistance Epic Software

Mobile EMS

None

Physio

Proprietary (i.e., developed specifically for your agency)

Rescue Medic EmergiData

Rescue Net

Safety Pad

TraumaSoft

Triptix by Intermedix

Zoll

Other (please specify)

Question Title

4. Approximately how many patient transports does your agency make per year? (Required.)

Question Title

5. If the integration software described in the email were available for our region at no or minimal cost to you, would your agency be interested in participating?

Yes

Other (please explain)

Question Title

* 1. Please give us your name and agency. (Required.)

Question Title

* 2. Does your agency use electronic or paper EMS reports ? (Required.)

Question Title

* 3. If you use an electronic EMS runsheet, which electronic EMS reporting system do you use? If solely using paper runsheets, click none. (Required.)

Question Title

* 4. Approximately how many patient transports does your agency make per year? (Required.)

Question Title

* 5. If the integration software described in the email were available for our region at no or minimal cost to you, would your agency be interested in participating?

1. Please give us your name and agency. (Required.)

2. Does your agency use electronic or paper EMS reports ? (Required.)

3. If you use an electronic EMS runsheet, which electronic EMS reporting system do you use? If solely using paper runsheets, click none. (Required.)

4. Approximately how many patient transports does your agency make per year? (Required.)

5. If the integration software described in the email were available for our region at no or minimal cost to you, would your agency be interested in participating?