Get the free Medical Control Physician Information Form - dhss delaware

Form intended for internal use by the Office of Emergency Medical Services in Delaware to gather information about physicians seeking to provide medical direction to EMS providers.

How to fill out medical control physician information

How to fill out Medical Control Physician Information Form

1. Obtain the Medical Control Physician Information Form from your healthcare facility or the relevant regulatory authority.
2. Fill in the physician's full name in the designated section.
3. Provide the physician's medical license number, ensuring it is accurate and up-to-date.
4. Enter the contact information, including phone number and email address, for the physician.
5. Include the name of the healthcare facility or organization where the physician practices.
6. Detail the physician's specialty or area of expertise, if required.
7. Review all filled information for accuracy before submission.
8. Submit the form to the appropriate department or regulatory body as instructed.

Who needs Medical Control Physician Information Form?

1. Healthcare providers who require medical oversight or guidance in emergency situations.
2. Emergency medical services (EMS) that need to establish protocols with a medical control physician.
3. Medical facilities that are implementing policies requiring oversight by certified medical professionals.
4. Regulatory authorities that require documentation of medical control for compliance purposes.

For pdfFiller’s FAQs

What is Medical Control Physician Information Form?

The Medical Control Physician Information Form is a document used to report and manage information related to physicians responsible for medical oversight in emergency medical services and prehospital settings.

Who is required to file Medical Control Physician Information Form?

Healthcare institutions, ambulance services, and emergency medical service providers that utilize medical control physicians are required to file the Medical Control Physician Information Form.

How to fill out Medical Control Physician Information Form?

To fill out the Medical Control Physician Information Form, an authorized representative must provide accurate details regarding the physician, including their name, credentials, contact information, and their role within the EMS system.

What is the purpose of Medical Control Physician Information Form?

The purpose of the Medical Control Physician Information Form is to ensure that there is proper documentation of medical oversight, facilitate communication between EMS providers and medical control, and maintain compliance with regulatory standards.

What information must be reported on Medical Control Physician Information Form?

The information that must be reported includes the physician's name, medical license number, contact information, affiliation with the EMS provider, and any relevant certifications or specialties.