Below are the common forms and guidelines which may be used throughout our interactions with patients, facilities, and other customers of Tri-State Ambulance.
GUNDERSEN MEDICAL DIRECTION PRE-HOSPITAL GUIDELINES (Wisconsin & Minnesota)
Gundersen Medical Direction offers an advanced set of pre-hospital guidelines.
GUNDERSEN MEDICAL DIRECTION PRE-HOSPITAL GUIDELINES (Iowa)
Gundersen Medical Direction offers an advanced set of pre-hospital guidelines.
Regional EMS Airway Management Checklist
This airway management checklist has been designed to improve all airway management processes with an emphasis on first pass success when performing endotracheal intubation.
Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Physician Certification Statement (PCS Form)
This form is required for inter-facility ambulance transports. The forms requires physician or a representative to sign and state why the patient requires ambulance transport.
Wisconsin Patient Side Training Report
Completion of this form designates that an ambulance service transported a medication that does not appear on the “Wisconsin Paramedic Curriculum Based Medication List” or the services approved operational plan.
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