Rescue Bill Form, Kirk & Associates

Rescue Information
Fire Company*
Incident Number*
Level of Rescue
Incident Type*	Vehicle Collision Vehicle Fire Spill/Hazmat Lock Out
Equipment Utilized
Equipment	Air tools Axe/halligen bar CO2 extinguisher Dry chem extinguisher Gas tank plug kit Glass master Hand lights Mounted power unit O-cutters Pedal cutter Portable power unit Rams small Rams large Saw-Zall Saw-Zall blades Secure battery Spreader Thermal image Toolbox Wrench 2x4 cribbing # minutes 4x4 cribbing # minutes Air bags # minutes Debris removal # minutes Extrication time # minutes Oil dry # bags Scene lighting # minutes Stabilization struts # minutes Step chock # used Traffic control # minutes
Incident Image
Image File 1*
Image File 2
Image File 3

Kirk & Associates LLC

56 W. Main St, Suite 203, Plaza 273Christiana, DE 19702 T: (302) 273-2247 T: (302) 273-2247 F: (302) 533-6818 F: (302) 533-6818

Services: medical billing, medical coding, physician billing, coding expertise, insurance verification, AR/denial management, collection agency, carrier contract negotiation, coding education, third party auditing, diagnostic coding, HIPAA compliant, ICD9 and ICD10 compatible.

Ruby Creek Design, An Albuquerque Web Design Company

Rescue Bill #2 Form

Rescue Information

Level of Rescue

Equipment Utilized

Incident Image