Communication Aid Resource Request

Communication Aid Resource Request

Our Communication Aid is a great resource to have on hand when there is a communication barrier with your patient and no interpreter available. You may find it effective with non-verbal patients, those that communicate with sign language, or speak a different language.

The resources provided by SD EMS for Children are available for organizations located within South Dakota. SD EMS for Children is not responsible for If you have any questions, please email us at sdemsc@usd.edu.

Organization*

Please list the official name of your organization. If you are requesting for a specific department within your organization, please add that here, too.

Organization Type*

Please select the option that best applies to your organization.

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Business Address*

City*

State*

Zip Code*

County*

Does your organization have a Pediatric Emergency Care Coordinator (PECC) or Pediatric Champion (PC)?*

If you do not, your DON or Organization Director can register one at www.sdemsc.org.

Select or enter value

PC/PECC Name*

Number of Resources Requested*

Requestor's Information

The following information should be contact information for the individual requesting the Pediatric Badge Resources.

First Name*

Last Name*

Email*

Phone Number*

Phone

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