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EMS Program:
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Date of Transport:
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Crew Members (if known):
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E-Mail for Follow Up (Required):
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E-Mail Confirm
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How did you find the site?
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Promptness of Helicopter to Scene:
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Accuracy of ETA:
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Respect was Shown to Your Crew:
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Concern was Shown to the Patient/Family:
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Clinical Competency was Shown by the Crew:
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Crisis Management Skills of the Team:
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Call Back was Received from the Crew:
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Comments/Questions
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