Outcome Requests

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Incident # (Please DO NOT put patient name)

Agency Name *Anaheim FireBrea FireCosta Mesa FireFountain Valley FireFullerton FireHuntington Beach FireLA County FireLaguna Beach FireNewport Beach FireOCFAOrange City FirePlacentia MedicOther

Receiving Hospital *Anaheim Global Medical CenterAnaheim RegionalCHOCFoothill RegionalFountain Valley RegionalGarden GroveHoag Hospital NewportHoag Hospital IrvineHuntington Beach HospitalKaiser AnaheimKaiser IrvineLa Palma IntercommunityLos Alamitos Medical CenterMission Hospital Laguna BeachMission Hospital Mission ViejoOrange Coast MemorialOC Global Medical CenterPlacentia LindaSaddleback MemorialSouth Coast Global Medical CenterSt JosephSt Jude Medical CenterUCIWest Anaheim Medical CenterUCI Irvine

Any specific issues you would like addressed?

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