Unusual Occurrence Reporting and Public Feedback

Print
Press Enter to show all options, press Tab go to next option

U.O. REPORTING & PUBLIC FEEDBACK

The Monterey County EMS Agency uses many quality improvement processes to provide the highest quality care to the citizens and visitors of Monterey County. EMS partners may use this form to report unusual occurrences or voice concerns in the system. Any member of the public may contact the agency for ambulance billing concerns, complaints, or general questions.

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

General Information for Report


1
Are you:
 *
2
Contact Information:
 *
Contact Information:
3
Subject of the Claim
 *
4
Incident Information
Incident Information

 

For Hospital Staff and EMS Personnel Use Only


5
Additional Incident Information
Additional Incident Information
6

Documentation to be sent to EMS Agency
Please select which information will be sent to EMS Agency.
Submit information so 436Emergency@co.monterey.ca.us

Documentation to be sent to EMS Agency • Please select which information will be sent to EMS Agency. • Submit information so 436Emergency@co.monterey.ca.us
7
Mandatory Reporting Event
8
Immediate Reporting Event
9

Remedial Education or Training Documentation
Submit information to 436Emergency@co.monterey.ca.us

Remedial Education or Training Documentation • Submit information to 436Emergency@co.monterey.ca.us
  1. To receive a copy of your submission, please fill out your email address below and submit.
    CAPTCHA
    Change the CAPTCHA codeSpeak the CAPTCHA code