UC Health EMS eFollow-up
Run Number:
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Date of Service:
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Hospital Name:
UC Medical Center
West Chester Hospital
Air Care and Mobile Care
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Patient Name:
*
Patient's DOB or SSN:
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Person Requesting Follow Up:
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Department:
(optional) Your Email address:
Did you suspect the patient was:
Sepsis
STEMI
Stroke
Trauma
Other
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What follow up information are you seeking?
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Required fields