Emergency Medical Services

Med Net Radio Problem Report Form

Use this form to submit a Med Net Radio Problem Report Form to the SJCEMSA office. The San Joaquin County Emergency Medical Services Agency may contact you after submission for clarification or further information. All fields are required.

Hospital Med Net Radio Problem Reporting Process Flowchart
After the patient was offloaded, was a radio test between the ambulance and hospital conducted?
Description of the problem
Possible cause(s)
Possible solution(s)
Who's completing this form?
Location Problem
Radio Type
Structure Type