Quality assurance inquiry

A Quality Assurance Inquiry is a tool we want EMTs and ED staff to use to create a line of communication between the Rescue Squads transporting to Aurora South Region hospitals and the Emergency Departments. Quality Assurance Inquiries can be used to notify us of a good or bad encounter.

Using the form below, please notify the EMS staff of any incident that occurs at one of the Aurora South Region hospitals. After clicking on submit, an Email will be sent to the Program Supervisor. After the email is received, an Inquiry will be generated. The Squad EMS Chiefs or Captain, Medical Control Doctors and Coordinators, ED Managers and anyone else that need's to be part of the review process will be notified and a follow up process will proceed as warranted.

Occurrence date:
Reported by:
Occurrence location:
Time:
Provider:
Run Number:
Individuals involved:





Deviation from protocol/SMG
Orders denied
Equipment difficulty
Request review
Positive encounter

Other encounter:
Description:
Entered by: