Forms
Annual Turnaround Document
2012 Annual ReCredentialling Instructions
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BLS Treatment Modalities
Epi-QI Form
This form is to be completed and sent to REMO within 2 business days of the use of an Epinephrine auto-injector.
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BLS Naloxone QI Form
This form is to be completed by the EMT/AEMT who has administered Naloxone to a patient using the BLS Naloxone protocol. This form should be returned, along with a copy of the completed PCR, to the appropriate Program Agency within 24 hours of administration in order to restock the BLS Naloxone Kit.
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BLS Albuterol QI Form
This form is to be completed by the EMT/AEMT-I who has administered Albuterol to a patient using the REMO Albuterol protocol. This form should be returned, along with a copy of the completed PCR. These should be returned with the yellow copies of the PCRs by the 15th of the next month
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Continuing Medical Education
CME Participant Survey
CICs can use this form as a program evaluation tool.
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CME Certificate
This certificate should be issued by a CIC at an approved CME. By using the "Sign" function of Adobe Reader a CIC can add text to the appropriate fields.
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CME Attendance
To be used for all attendees at a recognized CME
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Credentialing
REMO Credentialing Process
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2012 Annual ReCredentialling Instructions
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PAD and AED Information
PAD Usage QI Report
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REMO Collaborative Agreement
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PAD Quarterly Report
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Roles and Responsibilities for PAD Providers
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NYS Public Health Law Section 3000a-b
http://www.health.ny.gov/nysdoh/ems/art30.htm#BM3000b
The information contained on this website is not the official version of the New York State Public Health Law. No representation is made as to its accuracy. To ensure accuracy and for evidentiary purposes, reference should be made to the official version available on the New York State Legislature Web site. Click on the link for "Laws of New York" and then the link for "PBH Public Health".
The information contains legal definitions used in collaborative agreements.
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NYS Policy Statement 09-03 Re: PAD
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NYS PAD Notice of Intent
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PAD Checklist
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Other Forms
REMO RMA Form
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Report of Meaningful Positive Result
This form is to be used for all REMO providers whose skills and efforts at an EMS event are deserving of recognition.
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REMO ePCR Policy Agreement
As the electronic age advances REMO will continue to advance as well. In order to assist the regional agencies in meeting the demands of collecting electronic patient care data, the following policy has been
developed. In order to participate in an electronic PCR program agencies must complete this form.
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