EMS Provider Acknowledgement | Oakland County Medical Control Authority

The purpose of this referral is to recognize EMS personnel who provided exemplary patient care, going above and beyond standard care in a particular incident. If a particular incident fits this criteria, please fill out the information requested below and upload a copy of the run form.

The Peer Review and Recommendation Team will review all submissions and those chosen will be acknowledged at the next Medical Control Committee meeting. All information obtained through this process will remain confidential.
* Required Field

First Agency to be acknowledged:*
List name/names of personnel being acknowledged as you would like them to appear on the award certificate.*
Second Agency to be acknowledged:(if applicable)
List name/names of personnel being acknowledged as you would like them to appear on the award certificate.

EMS Run Form Incident Number:*
Date of Event:*
MM slash DD slash YYYY
Summarize the event and provide all necessary details:*
Please answer the following questions.
What made this run extraordinary?*
What was the patient outcome (if known)?*
Upload Run Report*

Drop files here or

Max. file size: 256 MB.
Check if no run report available:
- X
The information presented here is confidential professional/peer review Quality Assurance information of the OCMCA Board. It is protected from disclosure pursuant to the provisions of MCL 333.21518, MCL 333.20175, MCL 333.21515, MCL 331.531, MCL 331.533 and other state and federal laws. Unauthorized disclosure or duplication is absolutely prohibited.
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