Paramedic Case Review Request

Paramedic Case Review Request

This form is to be used by individual paramedics seeking a case review. Paramedic services, hospitals, and other organizations are to use the Organization Case Review Request form. Please do NOT enter any patient personal health information or identification into this form.

Please align your request with the details contained within the fields label.

Call Date

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Call Number (*)

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Paramedic Service (*)

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EHSN(*)

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Name(*)

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Email(*)

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Call Summary

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Reason for the review request (*)

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Is this call under any type of review? (*)

YES NO Invalid Input

Please note that (i) correspondence related to this case review will be via the ACE Tool, which your service leaders have access to; and (ii) as part of the review a QPS Specialist may ask you further questions and/or provide feedback on improving patient care.

In this section

Patient Safety Incident Report
Elective CME Pre-Approval Request
Data Request
Loss or theft of controlled substances
MedicASK
Service Forms
Return to Clinical Practice (Service Form)
Paramedic Case Review Request
Organization Case Review Request
Files

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