What is the purpose of the Request for Clarification Form?

• A. To notify the Resource Hospital EMS Coordinator of concerns involving prehospital patient care.
• B. To report patient demographic information in EMS records.
• C. To request funding for EMS equipment.
• D. To document hospital accreditation.

Answer: (A)

The form is a formal way to notify the Resource Hospital EMS Coordinator about concerns involving prehospital patient care. It isn’t used for collecting patient demographics, requesting funding for equipment, or documenting hospital accreditation. When a clinician spots a potential issue—such as a deviation from protocol, safety risk, or unclear orders—the form initiates a review and clarifying action by the EMS Coordinator to protect patient safety and uphold standards. Demographics belong in EMS records, funding goes through budgeting channels, and accreditation is handled by separate processes.