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EMS reporting forms

This page contains reporting forms for use by emergency medical service (EMS) agencies in Philadelphia.

The forms were produced by the Pennsylvania Department of Health’s Bureau of Emergency Medical Services. They are hosted here by the Philadelphia Regional Office of Emergency Medical Services (PROEMS).

You can request copies of public safety reports, including EMS reports, from the Department of Records.

Name Description Released Format
Ambulance collision and injury reporting form PDF Use this form to report an ambulance collision or injury to the regional EMS council. December 31, 2021
Transfer of care form PDF Use this form to report on patients when transferring their care. December 31, 2021
Approved patient care report vendors PDF A list of PA Department of Health approved vendors of patient care reports. December 31, 2021
Temporary replacement vehicle form PDF EMS agencies must submit this form in order to operate a temporary replacement EMS vehicle. December 14, 2022

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