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COUNTY OF MONTEREY

HEALTH DEPARTMENT

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EMS Feedback and Concerns

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EMS FEEDBACK & CONCERN FORM

The Monterey County EMS Agency uses many quality improvement processes to provide the highest quality care to the citizens and visitors of Monterey County. If you have a ambulance billing concern, complaint, general question, or would like to give positive feedback regarding the EMS system please let us know.


Please correct the field(s) marked in red below:

Contact Information

 *

Claim Information

Subject

 *

EMS Service Provider

 *

Incident Location

 *

Incident Date

 *
Invoice / Account Number
EMS Patient Care Report Number (PCR)
Patient Name on PCR
 *
Description Of Problem
 *
Problem Type
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