EZ-IO Regional Administration Program
This Form is intended to assisit NTRAC and the NORTEX EMS Provider's Association in surveillance of our EZ-IO program. Please fill out this formcompletely after each insertion of a needle using this device. Please do not place any Protected Health Information (PHI) on this form. This information will be kept secure and used in an effort of process improvement and data collection. A completed form will be necessary to obtain a replacement needle from the NTRAC/NREMSPA program.
|Q11||Site Selection check all that apply|
Placement Verification (check all that apply)
|Q21||Device Performed as Expected|