Continuous Quality Improvement (CQI)
These sample forms are intended to assist EMS services as they implement the November 09, 2011 revisions to 657-Chapter 11 (124.1, 147A, 155A) https://www.legis.iowa.gov/DOCS/ACO/IAC/LINC/Chapter.657.11.pdf : Drugs in Emergency Medical Service Programs.
Services may select from sample pharmacy-based, medical-director-based or combination pharmacy-based and medical-director based options. Services that select the combination option will submit each a pharmacy-based and a medical-director based agreement that clearly defines the ownership of specific drugs.
Sample Agreements and Forms
No Controlled Substances (CS) - Sample agreements and forms for services that carry Epi-pens and/or IV fluids or other prescription drugs, but do not carry controlled substances:
With Controlled Substances (CS) - Sample agreements and forms for services that carry prescription drugs including controlled substances:
With or Without Controlled Substances - Sample forms that may be helpful for services that do or do not carry controlled substances:
White Flashing Light Permit
Iowa law permits the use of white flashing lights for the identification of emergency medical care providers and service medical directors.