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SWORBHP Communication Form for Huron County Paramedic Services
Call Type
Call Type:
Self Report
Good Job
Service Inquiry
Patch Failure
Other…
Enter other…
Self Reports
First Name:
Last Name:
Email Address:
Phone Number:
EHS#:
Service:
- Select -
Huron
Your classification is:
- Select -
PCP
Are you an ACP or a PCP?
- Select -
ACP
PCP
Are you an ACP or a PCP?
- Select -
ACP
PCP
Are you an ACP or a PCP?
- Select -
ACP
PCP
Are you an ACP or a PCP?
- Select -
ACP
PCP
Your classification is:
- Select -
PCP
Call Date:
Run Number:
Details:
Details:
Please provide as much detail as possible, to ensure that we're able to assist you in a timely manner. Once you've completed all fields, please select the 'submit' button. You will receive an email confirmation once your submission has been successfully received.
