August 2025

Melanie Higgins, BS, NRP Captain – EMS Quality Assurance Division of Emergency Services 16232 Elliott Parkway Williamsport, MD 21795 (cell) 240-527-5940 (office) 240-313-4376 (fax) 240-313-4375 www.washco-md.net Authorized-ALS-Clinician-08-13-25.xlsx

Attached is a copy of the short form that you can readily reference and access to print should your unit run out of forms. Here is the on-line link as well www.miemss.org/home/forms – found under EMS clinician forms “preliminary EMS Report – Short form” Only an approved MIEMSS short form can be utilized. Please make