The purpose of this referral is to improve the quality and efficiency of patient care in the Tidewater region. This form is intended for positive and negative comments regarding EMS incidents in the Tidewater region. Submission of this document initiates further review of the specific incident. The intent of this form is to identify "system" issues. All information obtained through this process will remain confidential. This information will be used by a PI Committee, EMS Agency and/or Operational Medical Director (OMD) for the purposes of Quality Improvement (QI) and Performance Improvement (PI) with the ultimate goal being improved patient care and offer solutions to improve the system as a whole.