Reporting is encouraged by all who encounter an actual or potential patient event, potential patient safety event, system concerns, or exemplary care delivered within the Sacramento County EMS system in accordance with the California Health and Safety Code.
This information may be submitted anonymously. Please be advised that anonymous reporting may impact the ability to respond to your concern. Please include patient personal information only if pertinent to your report.
Please complete this form and click on submit to email the completed document. (Please do not modify the generated email)
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Complete the form then click on print and mail to:
Sacramento County EMS Agency
Attention: QIP Coordinator – Confidential
9616 Micron Ave, Suite 960
Sacramento, CA 95827
Please attach any supporting documents. Should you have any questions regarding this form or the reporting process, please contact Ben Merin at (916) 875-9785.
EMS Event Reporting form
Quality Improvement Program PD# 7600
Quality Assurance Program PD# 7602
Quality Improvement & Quality Assurance Policy Page
