Complaints and Compliance Issues Report
Thank you for taking the time to report a Complaints or Compliance Issue related to your EMS Privilege to Practice under the EMS Compact. This form is intended for EMS clinicians licensed in an EMS Compact Member Statewho have encountered challenges or compliance issues while practicing in another Compact state. Your submission will be reviewed by the EMS Compact staff, who may assist in resolving the issue by educating employers, state officials, or others on how the Compact operates.

Please provide as much detail as possible to help us assist you effectively.
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Email *
Name *
(If an EMS Clinician, the full legal name as it appears on your EMS license)
Phone Number *
A valid contact number is required to submit this form.
What best describes you? *
Home State? *
For the purpose of the Compact, what is your Home State? (The state that you are licensed in?)
Required
Which state are you experiencing a complaint or compliance issue in?
 *
Required
National EMS ID Number
If you are an EMS Clinician, what is your 12-Digit National EMS ID Number? This is required to validate your EMS Compact Privilege to Practice.  Retrieve your EMS ID from either your NREMT account or your State EMS Office.
What best describes the complaint or issue you are experiencing? *
Describe the complaint or compliance issue. 
 *
(Please include as much detail and specifics as possible. Include names, dates, and relevant contact details that may assist our office in reviewing and resolving the issue.)
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