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EMS Complaint Intake Form

Thank you for contacting us to file a complaint. This form is the first step in our intake process.

Information Needed

  • The nature of your complaint
  • Your contact information
  • The date(s) and location of the incident(s)
  • Details of the incident

What Happens Next

After you submit your complaint, someone from our office will contact you to discuss your complaint further. They may ask you for additional information or clarification.

We are committed to investigating all complaints thoroughly and fairly.

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Submit a complaint

EMS office does not have jurisdiction over any complaints not specifically addressed in Texas Administrative Code, Chapter 157 Rules.
The EMS office investigates complaints regarding disclosure of confidential information concerning a patient. But if your complaint is regarding a HIPAA violation, your concerns need to be addressed to the following: 
EMS office does not have jurisdiction over billing charges or disputes. You should address your concerns to the following:
  • directly to the EMS Provider (ambulance company) that did the ambulance treatment/transport or;
  • to the Texas Department of Insurance at Health insurance complaints (texas.gov) if your complaint is regarding your insurance company’s payment for the ambulance transportation or;
  • to the Texas Attorney General’s Office at Health Care Fraud and Abuse if you want to report fraudulent ambulance billing.
EMS office does not have jurisdiction over the rudeness or unprofessionalism of EMS personnel; this should be addressed with the person’s employer.

List and contact information for EMS Providers.

Complaint Intake

Which did the EMS agency provider violate?
With a company licensed or deemed eligible by the Texas Department of Insurance to do business in Texas in order to secure payment for any loss or damage resulting from any occurrence arising out of, or caused by the care, or lack of care, of a patient.
The provider shall maintain education and training records to include date, time, and location of such education or training for all its EMS personnel.
Assessment and Performance Improvement
Each EMS provider shall develop, implement, maintain, and evaluate an effective, ongoing, system-wide, data-driven, interdisciplinary quality assessment and performance improvement program. The program shall be individualized to the provider and shall, at a minimum, include:
Patient Care Reports
Assuring that patient care reports are provided to facilities receiving the patient:
Whenever operationally feasible.
If in a response-pending status.
the patient's name, patient's condition upon arrival at the scene; the prehospital care provided; the patient's condition during transport, including signs, symptoms, and responses to treatment during the transport; the call initiation time; dispatch time; scene arrival time; scene departure time; hospital arrival time; and, the identification of the ambulance staff. (subparagraph (C))
Medical Reports

Maintenance of medical reports

If a patient was younger than 18 years of age when last treated by the provider.
(Subchapter (E))
At the time of initial licensing and at each license renewal.
Department Notifications
Assuring that the department is notified within 30 business days whenever:
Operating Policies
Develop, implement and enforce written operating policies and procedures required under this chapter and/or adopted by the licensee. Assure that each employee (including volunteers) is provided a copy upon employment and whenever such policies and/or procedures are changed. A copy of the written operating policies and procedures shall be made available to the department on request. Policies at a minimum shall adequately address:
EMS Provider Discipline 157.16
EMS Provider Discipline 157.16
Relating to Requirements for an EMS Provider License.
This pulls in 157.11(n)(7).
This pulls in 157.11(n)(1)&(5).
Which did the EMS personnel violate?
157.36 EMS Personnel
Including signs, symptoms, and responses during duration of transport as per EMS provider’s approved policy.
or any institution or entity conducting EMS education and/or training or providing an EMS examination leading to obtaining certification or renewing certification or license.
which resulted in him or her being convicted or placed on a deferred adjudication community supervision or deferred disposition for any criminal offense, other than any class C misdemeanor not directly related to EMS or other than any offense noted in §157.37(e)(5) of this title (relating to Certification or Licensure of Persons With Criminal Backgrounds)
other than any class C misdemeanor not directly related to EMS or other than any offense noted in §157.37(e)(5) of this title.
which resulted in him or her being convicted or placed on deferred adjudication community supervision, or deferred disposition for any offense noted in §157.37(e)(5) of this title.
as determined by the provisions of §157.37 of this title, except that a person’s EMS certification or paramedic license shall be revoked if the certificant or licensed paramedic is convicted, or placed on deferred adjudication community supervision or deferred disposition for a criminal offense, noted in §157.37(e)(5) of this title.
In accordance with provisions in §157.37 of this title.
or could be reasonably expected to adversely impact the quality of care rendered to a patient.
This behavior is non-diagnostic and/or non-therapeutic, may be verbal or physical, and may include expressions or gestures that have sexual connotation or that a reasonable person would construe as such.
and/or providing patient care without medical direction when required

About the Agency or Person

If this complaint is about an ambulance transport – provide the County and City where the ambulance transport occurred.

Your Information

Address
Ambulance transport county and city
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