EMS Agency Electronic Patient Care Reporting (ePCRs) Question Title * 1. Please give us your name and agency. Name: Title: Agency: County: Email Address: Phone Number: Question Title * 2. Does your agency use electronic or paper EMS reports ? Electronic Paper Add comments if you wish. Question Title * 3. If you use an electronic EMS runsheet, which electronic EMS reporting system do you use? If solely using paper runsheets, click none. Alert Public Safety Solutions AmbuPro by OCI Software Cisco Clayton IDS Emergency Reporting Emergitech EMS Charts ESO Firehouse FirePrograms Software ImageTrend Medical Claims Assistance Epic Software Mobile EMS None Physio Proprietary (i.e., developed specifically for your agency) Rescue Medic EmergiData Rescue Net Safety Pad TraumaSoft Triptix by Intermedix Zoll Other (please specify) Question Title * 4. Approximately how many patient transports does your agency make per year? Question Title * 5. If the integration software described in the email were available for our region at no or minimal cost to you, would your agency be interested in participating? Yes No Other (please explain) Done