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Submit a Report

Drug Bag Exchange System Report Form

KCEMS West Michigan Drug Bag Exchange System Incident Report Form: This is a confidential professional standard review organization and/or quality assurance document of Kent County Emergency Medical Services, Inc. It is protected from disclosure pursuant to the provisions of Michigan law including: MCL 330.1143A, MCL 330.1748, MCL 331.531, MCL 331.532, MCL 331.20175, MCL 333.21513, MCL 333.21515 and all other applicable laws.

Agency Reporting a Problem:

Your Agency Type:

Date:

Time:

Name of Person Reporting the Problem:

Phone Number of Person Reporting the Problem:

Email of Person Reporting the Problem:

The Problem Involved:

Bag Number or Box Number:

Hospital Receiving Bag/Box:

Hospital That Last Filled/Checked the Box:

Date of Last Inspection:

Initials of Personnel Last Inspecting the Bag/Box:

EMS Agency That Used the Bag/Box:

Agency Type Where This Problem Originated:

If a Needle Was Left or Found in the Bag/Box, Was the Needle a Safety Needle?:

Yes
No
N/A

Description of the Problem:

Did this Effect Patient Care?:

Yes
No

Your MCA Area:

Security Code:

Note: The security code field provided
above is used to control email spam.
Please note that this field is case
sensitive.

Submit

Educational Calendar

The education calendar is a location for instructors to post new provider classes, CEUs and training opportunities for EMS providers throughout the area. To submit classes, please click on the Learn More link.

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Protocols by County

Please select this link to view protocols by MCA.

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Trauma Network

To move to the Trauma Network pages, please click here.

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Contact Us

To contact the Medical Control Authority for your area, please click here.

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