Front Matter 0-010-01 - Signature Page - Hard-Copy Signature Form

CMH EMS & MIH Protocols

Print this page and update the following to renew signatures. Once completed, return the hard-copy signature form to the CMH EMS Clinical Chief to remain on file. Completed form can be faxed (417-328-7209) or emailed (

Agencies you represent:
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Approval date:
By signing below, you certify the content of the version and date above are true, correct, and approved by you. You also attest your intension to implement, educate, and enforce the guidelines and protocols that apply to your agency/agencies.
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Change Log:

DateLink to
Description of change
07/05/20Moved this section from 0-010 onto its own page.
06/05/21pdfMoved to

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CMH Pre-Hospital Services Mission: "Provide safe, exceptional, and compassionate care to our communities with an emphasis on highly trained and empowered staff." CMH Mobile Integrated Healthcare Mission: "Provide exceptional, compassionate, and patient-centered care by a mobile collaborative team to improve patient experience, improve quality outcomes, and reduce healthcare costs."
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