Resources/Forms

Lake Plains Community Care Forms:

Monthly PCR Cover Sheet - PDF
Agency Information Update Form - PDF
Agency Roster Form - PDF
Agency Roster Form - Excel
Generic Refusal Form - PDF
Generic Prehospital Electronic PCR Drop Sheet - PDF

ePCR Information

Naloxone Utilization Report

Programs:

Epinephrine Auto Injector (EpiPen) Program
AED / PAD Program
BLS Albuterol Program
BLS Nasal Naloxone Program
BLS 12-Lead Acquisition and Transmission
BLS CPAP
BLS Blood Glucometry Program

BLSFR (Basic Life Support First Response):

New BLSFR Application
BLSFR Update

WREMAC:

Annual Skills/PPA Forms:

WREMAC Annual Skills Resources Page
WREMAC Policy #2013-1 - Revised May 21, 2015 - PDF
Agency Roster Form - Excel

WREMAC PPA Application - Fillable PDF

WREMAC Annual Skills Evaluation Forms - All levels - PDF

WREMAC Skills Sheets - All Levels
WREMAC Preceptor Information:
Approved WREMAC Skills Evaluators List
WREMAC Preceptor Application - Fillable PDF
Medical Director/Level of Care Change Forms:

Medical Director Verification Form
Change in Medical Director Packet - Fillable PDF
WREMAC Level Of Care Change/Upgrade - Fillable PDF