Section Menu EMS Feedback Form Your Experience at Owensboro Health Matters Denotes required fields Information Requested Patient Outcome Feedback Staff Member Feedback Contact InformationPatient outcomes are only provided if you are listed as a provider on the EMS chart associated with the patient transport. Contact InformationYour feedback is critical to improving our service. Please be as detailed as possible. Provider's First Name Last Name Email Phone? Preferred Method of Contact Phone Email Encounter Details Encounter Date/Time Encounter Date/Time: Date Encounter Date/Time: Time EMS Service Name Unit # Chief Complaint Patient MRN Please Describe Your Interaction with Hospital Staff Information Desired Regarding Patient Service Emergency Trauma Cardiac (STEMI) Neuro (STROKE) Burn Inpatient / Transfer Other… Enter other… Leave this field blank
