Get Emergency Department Visit Report Senator/representative 's ...

This guide provides clear, step-by-step instructions for completing the Emergency Department Visit Report used by senators and representatives. By following these instructions, you can efficiently fill out the form to facilitate communication and collaboration on important healthcare issues.

Follow the steps to complete the Emergency Department Visit Report accurately.

1. Click ‘Get Form’ button to obtain the document and open it in an appropriate online editor.
2. Begin by entering the name of the Senator or Representative at the top of the form, followed by their state.
3. Clearly print your name in the designated section to identify who is filling out the report.
4. Indicate whether the Senator or Representative attended the meeting by selecting ‘Yes’ or ‘No’.
5. List the individuals who attended the visit, including congressional staff and other physicians, ensuring that each person's role is specified.
6. In the issues section, respond to the medical liability question about sponsoring ACEP’s legislation by selecting ‘Yes’ or ‘No.’
7. Proceed to the mental health question and indicate support for mental health reform legislation by selecting ‘Yes’ or ‘No.’
8. Address the opioids question, expressing familiarity with efforts surrounding the opioid epidemic by selecting ‘Yes’ or ‘No.’
9. Respond to the EMS standing orders question regarding co-sponsoring legislation by selecting ‘Yes’ or ‘No.’
10. Provide any follow-up information or additional comments in the space provided.
11. Rate the overall visit using the options provided: Excellent, Good, Fair, or Poor.
12. After reviewing all entered information for accuracy, save your changes, and download or print the form for submission.

Complete your Emergency Department Visit Report online today to make your voice heard!