Complaints / Concerns

To submit a complaint or concern, fill out the form below. Further info is below this form.

Part A: Contact Information

Complainant Name:

Address:

City:

State:

Zip Code:

Phone Number:
(Example: 207-555-5555)

Email Address:

Date of Birth:
(Example: 01/01/2000)

Relationship to Patient:

Part B: Patient Information Same as complainant information

Patient Name:

Address:

City:

State:

Zip Code:

Phone Number:
(Example: 207-555-5555)

Email Address:

Date of Birth:
(Example: 01/01/2000)

Part C: Complaint Information

Name of EMS Agency:

Name of EMS prover(s) (if known):

Was Law Enforcement involved? if yes, name of law enforcement agency?:

Have you filed a complaint with the EMS Agency or provider?:

Have you filed a complaint with anyone else? If yes, with whom?:

Was your concern resolved?:

Dates of Service:

Narrative Information:

Please provide detailed information regarding your complaint.

Instructions:
The Maine EMS Board investigates complaints against individuals and agencies within the Maine EMS System in accordance with M.R.S. Title 32 Ch. 2-B. A complaint may be made against any of the following types of services:

A transporting service
A non-transporting service
An emergency medical dispatch center
A training center

As well as any individual EMS license holders at the following levels:

Emergency Vehicle Operator
Emergency Medical Responder
Emergency Medical Technician
Advanced EMT
Paramedic
Emergency Medical Dispatcher
Instructor Coordinator

IMPORTANT NOTE: The Department of Public Safety, or Maine Emergency Medical Services does not have jurisdiction over EMS billing practices and therefore does not investigate billing complaints. Pursuant to 32 M.R.S. § 91-B, complaints remain confidential during the pendency of an investigation. However, to investigate your complaint appropriately, it may be necessary to contact you. Providing your personal contact information will allow Maine EMS staff to contact you if necessary. Additionally, it may be necessary for Maine EMS Staff to speak with or receive statements from, witnesses, medical staff, or other involved parties.

Confidentiality: With limited exceptions, complaints and investigative records are confidential during the pendency of an investigation. The complaint and the complaint file become public upon the conclusion of an investigation, unless confidentiality is required by some other provision of law. However, patient treatment records obtained during investigation typically remain confidential, unless the release of those records is required by law.

Maine.gov