UC Health EMS eFollow-up

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