TSE Patient Follow-up Request Form

Healthcare providers, from both EMS and hospitals, can use this communication form to help them and their supervisor/educator obtain follow up feedback about provided care for TSE patients (Trauma, Stroke, STEMI, and Sepsis). After the form is submitted, a hospital representative will contact the provider to answer questions about the requested call and, if applicable, provide outcome data and any suggestions for improvement.

Please allow up to two weeks for follow up response. If you need immediate assistance, please reach out to your supervisor to follow up directly with Program Managers.