Notice of Privacy Practices
This form is required for inter-facility ambulance transports. The forms requires physician or a representative to sign and state why the patient requires ambulance transport.
For TSA Paramedic use. Completion of this form designates that an ambulance service transported a medication that does not appear on the “Wisconsin Paramedic
Curriculum Based Medication List” or the services approved operational plan.
Tri-State Ambulance medical direction offers an advanced set of pre-hospital protocols.