Friday, 24 January 2020

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If you are not able to submit your data by using this online form,
please print your information, make a note at the top of the problem you are having and fax your submission to the office at 757-963-2325.

TEMS Quarterly IV / Drug Box and MMRS DuoDot Kit Inventory

Taken on the Third Wednesday of March, June, September, and December

EMS Agency and/or Hospital Name:

EMS Agency Number:     Submitted by:    

E-Mail:              Phone Number:

Location Unit # Drug Box # Exp. Date IV Box # Exp. Date DuoDote # Seal Intact?

Platinum Partner

Platinum Partner

Gold Partner

Silver Partner
Silver Partner