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Forms and Information Requests

Essex Windsor Ambulance Vehicle

The following requests can be done using our online form submission:

Ambulance Call Report

All requests for copies of Ambulance Call Reports must be submitted to our Privacy Officer.

Proof of identification may be required from the individual granting authorization for release of their records. As of January 1, 2013, a service fee of $75.00 per ACR will be payable to the Corporation of the County of Essex before delivery of the requested document(s). Health Information Custodians and Law Enforcement Agencies are exempt from the service fee.

To request a copy of your Ambulance Call Report (ACR), you must first complete an Authorization for Release of Ambulance Call Report and submit it along with the service fee.

Cool Aid Form

Essex-Windsor EMS offers a Cool Aid program. The Cool Aid program is a form which, once completed is a way to help identify potential high-risk patients in emergency situations. The information on the form is used to assist paramedics in rendering the proper medical treatment if you are unable to communicate with them at the time of the emergency. It includes information about medical conditions, past history, current medications and allergies. There is also a provision for emergency contacts. Once you have completed the form it is to be placed on the front of your refrigerator with a magnet.

You can print the Cool Aid form at home, or request that one be sent to you by filling out our Cool Aid Request form.

Client Satisfaction Survey

We'd like to know how we're doing! We're always looking to make improvements, so if you or a close friend or family member have recently had interactions with someone from our service, please take a moment to fill out our online satisfaction survey.

Special event coverage / demonstration

If you would like to request medical coverage for your special event, or if you would like to request a paramedic presentation at your school, business or other location, please visit our special event coverage page.

Other forms and information (quick link):

Descriptions of these forms can be found in other areas of our website. We have placed them here for ease of reference:

Paramedic Recognition (information about this form can be found here)

CPR and AED Course Registration (information about this form can be found here)

Automated External Defibrillator (AED) Registration (information about this form can be found here)

Automated External Defibrillator (AED) Demonstration (information about this form can be found here)

Essex Windsor EMS Code of Privacy (pdf document)