Instructions:

1. Please fill out the following form in its entirety.
2. On the last page click submit and you will be redirected to the success page that will have a link to download a PDF copy of your submission.
3. Please have the PDF copy reviewed and signed by your Medical Control Physician.
4. Log back in to the Letters of Compliance User Options page and select edit.
5. On the last page of the form, check the box signifying that you have had the form signed, and a file upload box will appear.
6. Upload the signature page and select submit.

* Required Field

7. Number of Vehicles:

Please let the staff at the OCMCA know of any changes throughout the year.

COMPLIANCE:  If any of the above criteria cannot be met, the provider will submit documentation of the exceptions.

This agency agrees to comply with protocols, operating procedures and standards of pre-hospital care promulgated by MDHHS and the Oakland County Medical Control Authority, including the Agency and EMS Personnel Criteria for Participation Policy.  This will assure accountability for care rendered within our advanced emergency care system, effective this date, and as may be promulgated from time to time.

We acknowledge that each criterion and verification is subject to inspection by the EMS Medical Director or his/her physician designee, at any time, and at his/her direction.  Should cause exist, the EMS Medical Director, or, his/her designee may request formal verification.