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Drug Diversion Request Form:
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Virginia EMS Regulations 12VAC5-31-520.D requires an EMS Agency to notify the Office of Emergency Medical Services in writing of any diversion of (i.e., loss or theft) or tampering with any controlled substances, drug delivery devices, or other regulated medical devices from an agency, facility or vehicle. Notification shall be made within 15 days of the discovery of the occurrence.
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Drug Diversion
Date of Report
10/10/2024
Person Completing Report
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First Name
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MI
Last Name
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Address Line 1
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Address Line 2
ZIP
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City
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State
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Email
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Primary Phone #
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Alternate Phone #
Agency Name
ABINGDON AMBULANCE SERVICE - 00438
ABINGDON VOLUNTEER FIRE & RESCUE, INC. - 00291
ACCOMACK CO DEPT OF PUBLIC SAFETY - 00955
ADVANSIX-CHESTERFIELD - 00439
ADVANSIX-HOPEWELL - 00195
AEC MEDICAL TRANSPORT & RAPID RESPONSE - 50482
AIR EVAC EMS, INC. - 01251
AIRCARE - 01316
AIRLIFE VIRGINIA - 50470
ALBEMARLE COUNTY DEPARTMENT OF FIRE AND RESCUE - 00939
ALBERTA VOL. FIRE DEPARTMENT INC. - 01255
ALDIE VOLUNTEER FIRE COMPANY INC - 00646
AMBULANCE SERVICE OF BRISTOL INC - 00750
AMELIA COUNTY FIRE and EMS - 50625
AMELIA COUNTY VOLUNTEER FIRE DEPARTMENT - 00902
AMELIA EMERGENCY SQUAD - 00362
AMERICAN MEDICAL RESPONSE MID-ATLANTIC, INC / DBA AMR - 01257
AMHERST CO DEPT OF PUBLIC SAFETY - 01164
AMISSVILLE VOLUNTEER FIRE & RESCUE CO., INC. - 00031
APPALACHIA VOLUNTEER FIRE DEPARTMENT - 01133
APPOMATTOX VOLUNTEER RESCUE SQUAD - 00134
ARARAT RESCUE SQUAD - 00458
ARCOLA VOLUNTEER FIRE DEPARTMENT, INC. - 00079
ARI Transportation - 50591
ARLINGTON COUNTY FIRE DEPT - 00071
ASHBURN VOLUNTEER FIRE AND RESCUE DEPARTMENT - 00624
ASHLAND VOLUNTEER RESCUE SQUAD - 00390
ATLANTIC VOLUNTEER FIRE AND RESCUE DEPARTMENT - 00649
AUGUSTA COUNTY FIRE & RESCUE - 00632
AUGUSTA HEALTH TRANSPORTATION SERVICES - 01037
Angel Rides Inc. - 50655
Apex Medical Transport LLC - 50622
BACHELORS HALL VOLUNTEER FIRE DEPARTMENT - 00716
BASSETT RESCUE SQUAD INC - 00155
BATH COMMUNITY AMBULANCE SERVICE - 01215
BATH HIGHLAND VOLUNTEER FIRE DEPARTMENT - 01198
BAYWOOD SEARCH & RESCUE - 00514
BEDFORD CO DEPARTMENT OF FIRE AND RESCUE - 01197
BENSLEY-BERMUDA VOLUNTEER RESCUE SQUAD - 00194
BIG ISLAND EMERGENCY CREW - 00141
BIG STONE GAP RESCUE SQUAD INC - 00003
BLACKSBURG RESCUE SQUAD - 00222
BLACKSTONE FIRE DEPARTMENT - 00790
BLACKWATER VOLUNTEER RESCUE SQUAD - 00332
BLAIRS VOLUNTEER FIRE & RESCUE INC - 00616
BLAND COUNTY VOLUNTEER RESCUE SQUAD - 00199
BLOXOM VOLUNTEER FIRE COMPANY - 00454
BLUE RIDGE VOLUNTEER FIRE COMPANY - 00380
BLUE RIDGE VOLUNTEER RESCUE SQUAD - 00772
BOILING SPRINGS VOLUNTEER FIRE DEPARTMENT AND RESCUE SQUAD INC - 00235
BOLAR VOLUNTEER RESCUE SQUAD - 50529
BON SECOURS CRITICAL CARE TRANSPORT - 50567
BOONSBORO VOLUNTEER FIRE & RESCUE - 00557
BOTETOURT COUNTY FIRE & EMS - 01128
BOYCE VOLUNTEER FIRE COMPANY - 00691
BOYDTON LIFE STATION INC - 00553
BOYKINS VOLUNTEER FIRE DEPARTMENT & RESCUE SQUAD INC - 00323
BRANDY STATION VOLUNTEER FIRE DEPARTMENT - 00607
BRIDGEWATER VOLUNTEER RESCUE SQUAD - 00247
BRISTOL LIFE SAVING CREW, INC. - 00437
BROADWAY EMERGENCY SQUAD - 00049
BROSVILLE COMMUNITY VOLUNTEER FIRE DEPARTMENT - 00652
BRUNSWICK COUNTY SHERIFF'S OFFICE - 01328
BRUNSWICK EMERGENCY MEDICAL SERVICES - 01348
BUCKHALL VOLUNTEER FIRE & RESCUE - 00405
BUCKINGHAM COUNTY DEPARTMENT OF EMERGENCY SERVICES - 50541
BUENA VISTA FIREFIGHTERS INC. - 01302
BUENA VISTA RESCUE SQUAD - 00430
BUMPASS VOLUNTEER FIRE DEPARTMENT - 00695
BURKEVILLE VOLUNTEER FIRE DEPARTMENT - 00600
BUSCH GARDENS - WATER COUNTRY USA - 01086
BWX TECHNOLOGIES EMERGENCY TEAM - 00465
CALLANDS VOLUNTEER FIRE AND RESCUE INC - 00537
CALLAO RESCUE SQUAD INC - 00278
CAMP PEARY FIRE AND EMS - 00984
CAMPBELL COUNTY PUBLIC SAFETY - 01136
CAMPBELL COUNTY RESCUE SQUAD - 00367
CAPRON VOLUNTEER FIRE & FIRST AID SQUAD - 00324
CARDINAL AMBULANCE SERVICE, INC. - 01327
CARILION CLINIC PATIENT TRANSPORTATION - 00468
CAROLINE COUNTY DEPARTMENT OF FIRE AND RESCUE - 00944
CARROLL COUNTY FIRE & RESCUE - 01290
CARROLLTON VOLUNTEER FIRE DEPARTMENT - 00806
CASCADE VOLUNTEER FIRE DEPARTMENT - 01097
CASTLETON COMMUNITY VOLUNTEER FIRE COMPANY - 00098
CASTLEWOOD FIRE AND RESCUE, INC. - 00023
CATLETT VOLUNTEER FIRE & RESCUE COMPANY - 00844
CAVE SPRING FIRST AID & RESCUE SQUAD - 00036
CCDF VOLUNTEER FIRE DEPARTMENT & RESCUE SQUAD INC - 00156
CELANESE CORPORATION - 00217
CENTRA HEALTH INC - 00456
CENTRAL LIFE SAVING & RESCUE SQUAD - 00164
CHAMBLISSBURG FIRST AID & RESCUE CREW, INC. - 00140
CHARLES CITY COUNTY FIRE & EMERGENCY SERVICES - 50511
CHARLES CITY VOLUNTEER FIRE-EMS, INC. - 00827
CHARLOTTE COUNTY FIRE & RESCUE - 50639
CHARLOTTE COUNTY VOLUNTEER RESCUE SQUAD - 00173
CHARLOTTESVILLE FIRE DEPARTMENT - 00548
CHARLOTTESVILLE-ALBEMARLE RESCUE SQUAD - 00109
CHATHAM RESCUE SQUAD - 00160
CHESAPEAKE BEACH VOLUNTEER RESCUE SQUAD - 00356
CHESAPEAKE FIRE DEPARTMENT - 00449
CHESTER GAP VOLUNTEER FIRE DEPARTMENT - 00100
CHESTERFIELD FIRE AND EMS - 00504
CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS - 00315
CHILHOWIE AMBULANCE SERVICE, INC. / DBA C-TRANS MEDICAL SERVICES - 01169
CHINCOTEAGUE VOLUNTEER FIRE COMPANY - 00351
CHRISTIANSBURG RESCUE - 00223
CHURCHVILLE VOLUNTEER FIRE DEPARTMENT - 00363
CITY OF ALEXANDRIA FIRE DEPARTMENT - 00069
CITY OF BRISTOL FIRE DEPARTMENT - 00703
CITY OF COVINGTON EMS - 50475
CITY OF FAIRFAX FIRE DEPARTMENT - 00072
CITY OF HARRISONBURG FIRE DEPARTMENT - 00621
CITY OF MANASSAS FIRE AND RESCUE - 01287
CITY OF MANASSAS PARK FIRE DEPARTMENT - 00337
CITY OF NORTON FIRE DEPARTMENT - 01305
CITY OF RICHMOND DEPARTMENT OF FIRE & EMERGENCY SERVICES - 00452
CITY OF STAUNTON FIRE DEPARTMENT - 00642
CITY OF WAYNESBORO FIRE DEPARTMENT - 00620
CLARKE COUNTY FIRE & EMS - 01032
CLEAR BROOK VOLUNTEER FIRE & RESCUE INC. - 00529
CLEVELAND LIFESAVING CREW INC - 00020
CLIFTON FORGE FIRE DEPARTMENT - 01353
CLIFTON FORGE RESCUE SQUAD - 00229
CLINTWOOD VOLUNTEER RESCUE SQUAD, INC. - 00019
CLOVER HILL VOLUNTEER FIRE COMPANY - 00588
COLONIAL BEACH RESCUE SQUAD - 00280
COLONIAL BEACH VOLUNTEER FIRE DEPARTMENT INC - 00798
COLONIAL HEIGHTS FIRE/EMS - 00476
COMMUNITY FIRE COMPANY INC - 00348
CONCORD RESCUE SQUAD - 00128
COOL BRANCH RESCUE SQUAD - 00544
COPLE DISTRICT VOLUNTEER FIRE DEPARTMENT - 01270
COURTLAND VOLUNTEER RESCUE SQUAD - 00322
COVINGTON RESCUE SQUAD - 00408
CRAIG COUNTY EMERGENCY SERVICES - 01309
CRAIG COUNTY RESCUE SQUAD - EMS INC - 00368
CREEDS VOLUNTEER RESCUE SQUAD - 00333
CREWE VOLUNTEER FIRE DEPARTMENT - 01106
CULPEPER COUNTY OFFICE OF EMERGENCY SERVICES - 01027
CULPEPER COUNTY RESCUE SQUAD - 00103
CUMBERLAND FIRE & EMS - 01363
Chenega Global Protection, LLC / DBA NASA - Wallops Flight Facility - 50602
Coastal Event Medical Management / DBA Coastal Event - 50616
D19 TRANSPORTATION SERVICE INC. - 50527
DALE CITY VOLUNTEER FIRE DEPARTMENT - 00088
DAMASCUS VOLUNTEER RESCUE SQUAD INC - 00484
DANTE RESCUE SQUAD INC - 00024
DANVILLE FIRE DEPARTMENT - 00626
DANVILLE LIFE SAVING & FIRST AID CREW INC - 00410
DAVENPORT LIFESAVING CREW INC - 00014
DAVIS CORNER VOLUNTEER RESCUE SQUAD - 00425
DELTA MEDICAL TRANSPORT - 01336
DELTA RESPONSE TEAM, LLC - 01303
DICKENSON COUNTY AMBULANCE SERVICE - 00018
DINWIDDIE COUNTY FIRE AND EMS - 00785
DLA RICHMOND FIRE & EMERGENCY SERVICES - 00946
DOOMS VOLUNTEER FIRE DEPARTMENT - 00628
DRY FORK VOLUNTEER FIRE DEPARTMENT INC - 00915
DRYDEN FIRE DEPARTMENT - 50491
DUFFIELD VOLUNTEER FIRE & RESCUE - 00473
DUMFRIES-TRIANGLE VOLUNTEER FIRE DEPARTMENT - 00711
DUNLAP FIRE AND RESCUE - 00120
Dyke Volunteer Fire Company, Inc. - 50659
EAST HANOVER VOLUNTEER RESCUE SQUAD INC - 00257
ELK CREEK RESCUE SQUAD - 00684
EMERGENCY SERVICES SOLUTIONS, INC. - 50472
EMERGENCY TRAINING SYSTEMS, INC. - 01291
EMERGILITY - 50537
ESSEX COUNTY EMS - 01310
ETTRICK-MATOACA VOLUNTEER RESCUE SQUAD - 00182
EVENT MEDICAL STANDBY - 01117
EVINGTON VOLUNTEER FIRE DEPARTMENT - 01031
FABS FAMILY MEDICAL TRANSPORT - 50615
FAIRFAX COUNTY FIRE & RESCUE - 00253
FAIRFAX COUNTY POLICE DEPARTMENT - 00375
FAIRFIELD VOLUNTEER RESCUE SQUAD - 00032
FAIRYSTONE VOLUNTEER FIRE DEPARTMENT, INC - 01292
FALLING SPRING RESCUE SQUAD INC - 00234
FARMVILLE VOLUNTEER FIRE DEPARTMENT - 50487
FAST TRACK EMS, LLC - 01356
FAUQUIER COUNTY FIRE - RESCUE - 00656
FIELDALE-COLLINSVILLE RESCUE SQUAD - 00153
FLOYD COUNTY EMS INC - 01219
FLOYD COUNTY LIFE SAVING AND FIRST AID SQUAD INC - 00216
FLUVANNA COUNTY DEPARTMENT OF EMERGENCY SERVICES - 50528
FLUVANNA COUNTY VOLUNTEER FIRE DEPARTMENT - 00903
FOREST VIEW VOLUNTEER RESCUE SQUAD - 00265
FORT A P HILL FIRE DEPARTMENT - 00924
FORT BARFOOT FIRE AND EMERGENCY SERVICES - 00969
FORT BELVIOR COMMUNITY HOSPITAL EMS - 00966
FORT BELVOIR FIRE DEPARTMENT - 00707
FORT EUSTIS/FORT STORY FIRE & EMERGENCY SERVICES - 01122
FORT VALLEY VOLUNTEER FIRE DEPARTMENT - 01042
FRANKLIN COUNTY DEPARTMENT OF PUBLIC SAFETY - 00594
FRANKLIN FIRE & RESCUE - 00412
FREDERICK COUNTY FIRE & RESCUE DEPARTMENT - 00595
FREDERICKSBURG FIRE DEPARTMENT - 00511
FREDERICKSBURG RESCUE SQUAD - 00267
FRIES VOLUNTEER FIRE DEPARTMENT & RESCUE SQUAD - 00389
FRONT ROYAL VOLUNTEER FIRE AND RESCUE DEPARTMENT, INC. - 00252
Fort Gregg-Adams Fire & Emergency services - 00925
G & W AMBULANCE INC - 00737
GAINESBORO VOLUNTEER FIRE AND RESCUE COMPANY - 00532
GALAX FIRE DEPARTMENT & RESCUE - 00414
GALAX-GRAYSON EMERGENCY MEDICAL SERVICES - 00196
GASBURG VOLUNTEER FIRE DEPARTMENT - 01329
GERDAU - 00978
GILES LIFESAVING AND RESCUE SQUAD INC - 00218
GLADSTONE VOLUNTEER FIRE & RESCUE SERVICES - 01319
GLASGOW LIFE SAVING & FIRST AID CREW INC - 00051
GLEN LYN VOLUNTEER FIRE & RESCUE DEPARTMENT - 50555
GLOUCESTER VOLUNTEER FIRE & RESCUE SQUAD, INC. - 00382
GOLDVEIN VOLUNTEER FIRE & RESCUE DEPARTMENT - 00583
GOOCHLAND COUNTY DEPARTMENT OF FIRE-RESCUE AND EMERGENCY SERVICES - 00597
GOODSON-KINDERHOOK VOLUNTEER FIRE DEPARTMENT - 00854
GOODYEAR TIRE AND RUBBER COMPANY - 01118
GORE VOLUNTEER FIRE AND RESCUE - 00531
GOSHEN FIRST AID CREW - 00052
GREENBACKVILLE VOLUNTEER FIRE DEPARTMENT - 00354
GREENE COUNTY EMS - 01330
GREENSVILLE VOLUNTEER RESCUE SQUAD - 00406
GREENWOOD VOLUNTEER FIRE & RESCUE COMPANY INC - 00495
GREIF, INC. - RIVERVILLE MILL EMS - 00490
GRETNA RESCUE SQUAD - 00159
GROTTOES RESCUE SQUAD - 00050
GROTTOES VOLUNTEER FIRE DEPARTMENT - 00629
GUARDIAN MEDICAL SERVICES - 50512
Grayson County Emergency Services - 50609
Green Spring Volunteer Fire Department Station 160 - 50664
HALIFAX COUNTY FIRE COMMISSION - 00650
HALIFAX COUNTY RESCUE SQUAD - 00169
HAMILTON VOLUNTEER RESCUE SQUAD - 00080
HAMPDEN-SYDNEY VOLUNTEER FIRE DEPARTMENT INC - 00608
HAMPTON DIVISION OF FIRE/RESCUE - 00417
HANOVER FIRE EMS - 00779
HARDY LIFESAVING & RESCUE INC - 00401
HARRISONBURG RESCUE SQUAD - 00245
HAYSI RESCUE SQUAD - 00371
HENRICO COUNTY DIVISION OF FIRE - 00542
HENRY COUNTY DEPARTMENT OF PUBLIC SAFETY - 00647
HIGHLAND COUNTY DEPARTMENT OF EMS - 50490
HIGHLAND COUNTY VOLUNTEER RESCUE SQUAD - 00237
HIGHLANDS AMBULANCE SERVICE INC - 00948
HOLLY GROVE VOLUNTEER RESCUE SQUAD - 00117
HOPEWELL FIRE & EMS - 00713
HOT SPRINGS VOLUNTEER FIRE AND RESCUE ASSOCIATION INC. - 00239
HUDDLESTON LIFE SAVING & FIRST AID CREW INC - 00135
Hospital to Home, LLC / DBA H2H Emergency Services - 50594
INCARNATE AMBULANCE SERVICE INC - 50552
INDEPENDENCE VOLUNTEER RESCUE SQUAD - 00198
IRON GATE VOLUNTEER FIRE DEPARTMENT - 01289
ISLE OF WIGHT FIRE-RESCUE - 01052
ISLE OF WIGHT VOLUNTEER RESCUE SQUAD, INC. - 00310
IVOR VOLUNTEER RESCUE SQUAD - 00321
JAMES CITY COUNTY FIRE DEPARTMENT - 00339
JAMES CITY RESCUE SQUAD - 00187
JARRATT VOLUNTEER FIRE DEPARTMENT - 01112
JEB STUART RESCUE SQUAD - 00158
JOHN H. ENDERS VOLUNTEER FIRE & RESCUE SQUAD COMPANY - 00058
JONESVILLE RESCUE SQUAD - 00871
KEMPSVILLE VOLUNTEER RESCUE SQUAD - 00335
KENTUCK VOLUNTEER FIRE DEPARTMENT, INC. - 01095
KEOKEE VOLUNTEER FIRE & RESCUE - 00807
KERR'S CREEK VOLUNTEER FIRE DEPARTMENT - 00623
KILMARNOCK-LANCASTER VOLUNTEER RESCUE SQUAD - 00283
KING & QUEEN COUNTY DEPARTMENT OF EMERGENCY SERVICES - 01331
KING & QUEEN VOL. RESCUE SQUAD - 00294
KING GEORGE DEPARTMENT OF FIRE,RESCUE AND EMERGENCY SERVICES - 01013
KING WILLIAM COUNTY FIRE & EMERGENCY SERVICES - 01362
KINGS DOMINION - 00186
KIWI EMERGENCY MEDICAL SERVICES - 50586
KNOX CREEK VOLUNTEER FIRE DEPARTMENT INC. - 50544
LAKE ANNA RESCUE, INC - 00987
LAKE GASTON VOLUNTEER FIRE DEPARTMENT - 01300
LAKE JACKSON VOLUNTEER FIRE DEPARTMENT - 00083
LAKE MONTICELLO VOLUNTEER RESCUE SQUAD - 00114
LAKE OF THE WOODS VOLUNTEER FIRE & RESCUE - 00435
LAKESIDE VOLUNTEER RESCUE SQUAD - 00184
LANCASTER COUNTY EMERGENCY SERVICES - 01192
LANGLEY AIR FORCE BASE - 00681
LAUREL RESCUE SQUAD - 00201
LEAD MINES RESCUE SQUAD - 00211
LEBANON LIFE SAVING CREW - 00446
LEESBURG VOLUNTEER FIRE COMPANY, INC. - 00788
LEXINGTON FIRE DEPARTMENT - 01264
LIFECARE AMBULANCE SERVICE INC. - 00470
LIFECARE MEDICAL TRANSPORTS LLC - 00749
LIFESTAR AMBULANCE SERVICE, INC. - 01040
LITTLE FORK VOLUNTEER FIRE & RESCUE COMPANY - 00793
LONG SHOP-MCCOY VOLUNTEER FIRE DEPARTMENT/RESCUE SQUAD - 00224
LOUDOUN COUNTY FIRE AND RESCUE - 00534
LOUDOUN COUNTY VOLUNTEER RESCUE SQUAD - 00398
LOUISA COUNTY DEPARTMENT OF FIRE AND EMS - 00991
LOUISA COUNTY RESCUE SQUAD - 00400
LOVETTSVILLE DISTRICT FIRE & RESCUE - 00074
LURAY VOLUNTEER RESCUE SQUAD - 00250
LYNCHBURG FIRE DEPARTMENT - 00143
Legacy EMS, INC. - 50619
LifeWay Medical Transport, LLC - 50618
MADISON COUNTY EMERGENCY MEDICAL SERVICES - 01029
MANCHESTER VOLUNTEER RESCUE SQUAD - 00193
MANGOHICK VOLUNTEER FIRE DEPARTMENT, INC. - 01069
MARSHALL VOLUNTEER FIRE & RESCUE DEPARTMENT - 00105
MARTINSVILLE FIRE & EMS - 00835
MARYLAND AND MID-ATLANTIC WILDERNESS RESCUE SQUAD/AUSTERE MEDICAL PROFESSIONAL - 50532
MATHEWS VOLUNTEER RESCUE SQUAD - 00295
MB SOLUTIONS, LLC. - 01359
MCDONALD ARMY HEALTH CENTER - 00929
MECKLENBURG COUNTY EMERGENCY SERVICES - 50626
MECKLENBURG COUNTY SHERIFF'S OFFICE - 01276
MED-TRANS CORPORATION / DBA CARILION CLINIC LIFE-GUARD - 01321
MED-TRANS CORPORATION / DBA HIGHLANDS EMERGENCY AIR RESCUE AND TRANSPORT - 01250
MED-TRANS CORPORATION / DBA LIFEEVAC - 50556
MEDICAL READINESS GROUP, LLC - 50599
MEHERRIN VOLUNTEER FIRE & RESCUE, INC. - 01017
MELFA VOLUNTEER FIRE & RESCUE - 00352
MERCK & CO INC - 01024
MERCY AMBULANCE SERVICE - 00838
METRO-WASHINGTON AIRPORT AUTHORITY FIRE/RESCUE DEPT - 00505
MID-COUNTY VOLUNTEER RESCUE SQUAD - 00488
MIDDLESEX COUNTY VOLUNTEER RESCUE SQUAD, INC. - 00403
MIDDLETOWN VOLUNTEER FIRE/RESCUE - 00248
MILLBORO AREA RESCUE SQUAD - 01011
MILLWOOD STATION VOLUNTEER FIRE & RESCUE COMPANY 21 INC - 00055
MOLSON/COORS BEVERAGE COMPANY - 00541
MONELISON VOLUNTEER RESCUE SQUAD - 00133
MONETA RESCUE SQUAD, INC. - 00137
MONTGOMERY COUNTY FIRE-EMS - 50581
MONTVALE RESCUE SQUAD - 00139
MOUNT HERMON VOLUNTEER FIRE & RESCUE INC. - 00653
MOUNT JACKSON RESCUE & FIRE DEPARTMENT, INC. - 00066
MOUNT ROGERS VOLUNTEER FIRE DEPARTMENT & RESCUE SQUAD - 00387
MOUNT SOLON VOL FIRE CO/RESCUE SQUAD INC - 00636
Midwest Medical Transport, LLC / DBA MMT Ambulance - 50587
NARROWS FIRE DEPARTMENT INC. - 50596
NATURAL BRIDGE VOLUNTEER FIRE DEPARTMENT - 00817
NAVAL SUPPORT ACTIVITY (NSA) SOUTH POTOMAC DAHLGREN - 00973
NAVY REGION MID-ATLANTIC FIRE & EMERGENCY SERVICES - 00422
NEBO VOLUNTEER FIRE DEPARTMENT - 00721
NEW BALTIMORE VOLUNTEER FIRE COMPANY - 00709
NEW GARDEN RESCUE SQUAD - 00021
NEW KENT FIRE-RESCUE - 00693
NEWPORT NEWS FIRE DEPARTMENT - 00346
NEWPORT NEWS SHIPBUILDING FIRE DEPARTMENT - 00345
NEWPORT VOLUNTEER RESCUE SQUAD - 00648
NEWSOMS VOLUNTEER FIRE DEPARTMENT, INC. - 01350
NICKELSVILLE RESCUE SQUAD - 00474
NIGHTINGALE AIR AMBULANCE - 00509
NOKESVILLE VOLUNTEER FIRE DEPARTMENT & RESCUE SQUAD - 00086
NORFOLK AIRPORT AUTHORITY FIRE DEPARTMENT - 00877
NORFOLK DIVISION FEDERAL BUREAU OF INVESTIGATION - 00897
NORFOLK FIRE-RESCUE - 00319
NORTH ANNA POWER STATION - 00118
NORTH GARDEN VOLUNTEER FIRE COMPANY - 00710
NORTH HALIFAX VOLUNTEER FIRE DEPARTMENT - 01271
NORTH MOUNTAIN VOLUNTEER FIRE & RESCUE - 00528
NORTHAMPTON COUNTY DEPARTMENT OF EMS - 01100
NORTHUMBERLAND COUNTY RESCUE SQUAD - 00277
NORTHUMBERLAND DEPARTMENT OF EMERGENCY SERVICES - 01346
NORTON RESCUE SQUAD - 00002
NOTTOWAY COUNTY EMERGENCY SQUAD - 00180
O'GARA TRAINING AND SERVICES, LLC. - 01368
O.W.L. FIRE DEPARTMENT & RESCUE SQUAD - 00089
OAK GROVE VOLUNTEER FIRE DEPARTMENT - 00867
OAK HALL RESCUE, INC. - 00376
OAKWOOD FIRE & RESCUE - 00379
OCEAN PARK VOLUNTEER RESCUE SQUAD - 00327
ONANCOCK VOLUNTEER FIRE DEPARTMENT - 00350
ORANGE COUNTY DEPARTMENT OF FIRE & EMS - 00964
ORKNEY SPRINGS FIRE & RESCUE, INC. - 01243
ORLEAN VOLUNTEER FIRE COMPANY, INC. - 00808
PAGE COUNTY FIRE - EMS - 01190
PAINT BANK FIRE & RESCUE - 00510
PARKSLEY VOLUNTEER FIRE COMPANY, INC. - 00353
PATIENT TRANSPORT SYSTEMS - 00507
PATRICK COUNTY FIRE AND EMS - 01279
PETERSBURG FIRE DEPARTMENT - 00483
PHI HEALTH, LLC / DBA PHI AIR MEDICAL - 01242
PHILIP MORRIS USA - 01072
PIPERS GAP RESCUE SQUAD - 00394
PITTSYLVANIA COUNTY PUBLIC SAFETY - 50478
PLAZA VOLUNTEER RESCUE SQUAD - 00329
POQUOSON FIRE & RESCUE - 00340
PORTSMOUTH FIRE, RESCUE & EMERGENCY SERVICES - 00421
POUND RESCUE SQUAD, INC. - 00006
POWHATAN FIRE AND RESCUE DEPARTMENT - 00701
PRATER VOLUNTEER RESCUE SQUAD, INC. - 00843
PRINCE EDWARD VOLUNTEER RESCUE SQUAD - 00170
PRINCE GEORGE FIRE AND EMS - 00296
PRINCE WILLIAM COUNTY DEPARTMENT OF FIRE & RESCUE - 00090
PRINCESS ANNE COURTHOUSE VOLUNTEER RESCUE SQUAD - 00336
PRIORITY PATIENT TRANSPORT, INC. - 01262
PULASKI COUNTY PUBLIC SAFETY - 00856
PURCELLVILLE VOLUNTEER FIRE DEPARTMENT - 01041
PURCELLVILLE VOLUNTEER RESCUE SQUAD, INC. - 00081
Pro Med Ambulance Company - 50658
QUANTICO FIRE DEPARTMENT - 00935
Ques Transport LLC - 50661
RADFORD ARMY AMMUNITION FIRE/RESCUE - 01055
RADFORD FIRE/EMS - 01067
RADFORD UNIVERSITY EMS - 00718
RAPHINE VOLUNTEER FIRE COMPANY INC - 00758
RAPPAHANNOCK COUNTY FIRE & RESCUE - 50582
READ MOUNTAIN FIRE/RESCUE - 00689
RELIANCE MEDICAL TRANSPORT - 01339
REMINGTON VOLUNTEER FIRE & RESCUE DEPARTMENT, INC. - 00107
REPUBLIC AMBULANCE SERVICE - 00558
RESCUE 33 AMBULANCE SERVICE, INC. - 01142
REVA VOLUNTEER FIRE & RESCUE - 00883
REYNOLDS STORE FIRE COMPANY - 00525
RICHARDSON AMBULANCE SERVICE - 01317
RICHARDSVILLE VOLUNTEER FIRE DEPARTMENT/RESCUE SQUAD, INC. - 00102
RICHMOND AMBULANCE AUTHORITY - 00579
RICHMOND COUNTY EMERGENCY MEDICAL SERVICES - 01284
RICHMOND INTERNATIONAL AIRPORT FIRE DEPARTMENT - 00639
RICHMOND VOLUNTEER RESCUE SQUAD - 00260
RIDE24 LLC - 50662
RIDGEWAY DISTRICT RESCUE SQUAD, INC. - 00331
RINER VOLUNTEER RESCUE SQUAD INC. - 01307
RINGGOLD VOLUNTEER FIRE DEPARTMENT - 00657
RIVERHEADS VOLUNTEER FIRE DEPT., INC. - 01306
ROANOKE COUNTY FIRE & RESCUE - 00442
ROANOKE EMERGENCY MEDICAL SERVICES INC - 00560
ROANOKE FIRE - EMS DEPARTMENT - 00043
ROBBIE'S AMBULANCE SERVICE, INC. - 01344
ROCKBRIDGE BATHS VOLUNTEER FIRE DEPARTMENT - 00761
ROCKBRIDGE COUNTY FIRE & RESCUE - 01314
ROCKFISH VALLEY VOLUNTEER FIRE DEPARTMENT - 00053
ROCKHILL VOLUNTEER RESCUE SQUAD - 00272
ROCKINGHAM CO FIRE/RESCUE - 00601
ROCKY MOUNTAIN HOLDINGS LLC / DBA AIR CARE EAGLE - 50607
ROCKY MOUNTAIN HOLDINGS, LLC / DBA HEALTH NET AEROMEDICAL SERVICE - 01352
ROSELAND RESCUE SQUAD, INC. - 00113
ROUND HILL COMMUNITY FIRE & RESCUE CO., INC. - 00526
ROUND HILL VOLUNTEER FIRE & RESCUE DEPARTMENT - 00397
RUCKERSVILLE VOLUNTEER FIRE COMPANY, INC. - 00804
RUGBY VOLUNTEER RESCUE SQUAD & FIRE DEPARTMENT INC. - 00197
SALEM FIRE - EMS DEPARTMENT - 00589
SALEM RESCUE SQUAD - 00228
SALEM VOLUNTEER FIRE DEPARTMENT - 00472
SANDBRIDGE VOLUNTEER RESCUE SQUAD - 00334
SANDY RIDGE VOLUNTEER RESCUE SQUAD - 00330
SAXIS VOLUNTEER FIRE AND RESCUE, INC. - 00377
SCOTT COUNTY LIFE SAVING CREW, INC. - 00361
SCOTTSVILLE VOLUNTEER FIRE DEPARTMENT - 00767
SCRUGGS FIRE DEPARTMENT AND RESCUE SQUAD, INC. - 00145
SEDLEY VOLUNTEER FIRE DEPARTMENT - 01125
SELMA VOLUNTEER FIRE DEPARTMENT AND FIRST RESPONDERS - 01325
SEMINOLE TRAIL VOLUNTEER FIRE DEPARTMENT - 00771
SHADY GROVE FIRE & RESCUE - 01002
SHARON VOLUNTEER FIRE DEPARTMENT, INC. - 00900
SHENANDOAH COUNTY FIRE AND RESCUE - 01162
SHENANDOAH VALLEY REGIONAL AIRPORT ARFF DEPARTMENT - 00997
SHORE TRANSPORT SERVICES, INC. - 01340
SINGERS GLEN VOLUNTEER FIRE COMPANY - 00766
SINGERS GLEN VOLUNTEER RESCUE SQUAD, INC - 00816
SMITH RIVER RESCUE SQUAD - 00466
SOUTH BOSTON FIRE DEPARTMENT - 50506
SOUTH RIVER DISTRICT VOLUNTEER FIRE DEPARTMENT - 01010
SOUTHSIDE RESCUE SQUAD, INC - 00166
SOUTHSIDE VIRGINIA EMERGENCY CREW - 00298
SPECIAL EVENT PROVIDERS OF EMERGENCY MEDICINE - 01288
SPERRYVILLE VOLUNTEER RESCUE SQUAD - 00097
SPOTSYLVANIA COUNTY FIRE & RESCUE - 00573
SPOTSYLVANIA VOLUNTEER RESCUE SQUAD INC. - 00276
SPRUANCE EMERGENCY SERVICES - 00572
ST. CHARLES VOLUNTEER RESCUE SQUAD, INC. - 00970
STAFFORD COUNTY FIRE AND RESCUE DEPARTMENT - 00578
STANARDSVILLE VOLUNTEER FIRE COMPANY - 01285
STANLEY VOLUNTEER FIRE DEPARTMENT - 01054
STANLEY VOLUNTEER RESCUE SQUAD - 00251
STAR TANNERY VOLUNTEER FIRE DEPARTMENT - 00527
STAUNTON-AUGUSTA RESCUE SQUAD - 00423
STEPHENS CITY VOLUNTEER FIRE & RESCUE COMPANY - 00530
STERLING VOLUNTEER FIRE COMPANY - 00688
STERLING VOLUNTEER RESCUE SQUAD - 00076
STEWARTSVILLE FIRST AID & RESCUE SQUAD - 00138
STONE HOUSE VOLUNTEER FIRE DEPARTMENT & RESCUE SQUAD, INC. - 00084
STONY CREEK VOLUNTEER RESCUE SQUAD, INC. - 00304
STONY POINT VOLUNTEER FIRE COMPANY - 00755
STRASBURG VOLUNTEER RESCUE SQUAD - 00064
STUART VOLUNTEER FIRE DEPARTMENT - 01272
STUARTS DRAFT RESCUE SQUAD - 00364
SUFFOLK FIRE & RESCUE - 00741
SUGAR GROVE LIFE SAVING CREW, INC. - 00204
SUNRISE MEDICAL TRANS LLC - 50553
SURRY NUCLEAR POWER STATION - 00428
SWOOPE VOLUNTEER FIRE COMPANY - 01268
Smyth County Fire Rescue - 50627
Surry County Board of Supervisors / DBA Surry County Emergency Medical Services - 50614
TAC MEDICAL LLC - 50598
TANGIER VOLUNTEER FIRE DEPARTMENT - 01326
TANNERSVILLE RESCUE SQUAD - 00512
TAZEWELL COUNTY EMS - 01364
THE LYCRA COMPANY LLC - 50469
THE PLAINS VOLUNTEER FIRE COMPANY - 00374
THE TROUTDALE COMMUNITY VOLUNTEER FIRE DEPT & RESCUE SQUAD - 00388
THOMAS WALKER RESCUE SQUAD - 00009
THOMPSON VALLEY RESCUE SQUAD - 00834
TIDEWATER MEDICAL TRANSPORT, INC. - 01333
TOWN OF CHILHOWIE FIRE & EMS DEPARTMENT - 00979
TOWN OF HAYSI - 50525
TOWN OF MARION, MARION FIRE/EMS - 01345
TOWN OF RICHLANDS - 01269
TOWN OF TAZEWELL EMS - 01342
TRI COUNTY TRANSPORT - 50507
TRIANGLE VOLUNTEER FIRE DEPARTMENT - 50576
TRINITY AMBULANCE SERVICE, LLC. - 01308
TUCKAHOE VOLUNTEER RESCUE SQUAD - 00183
TUNSTALL VOLUNTEER FIRE DEPARTMENT - 00622
TURBEVILLE VOLUNTEER FIRE AND RESCUE ASSOCIATION INC. - 01275
Town of Pennington Gap, Inc. - 50606
Town of St. Paul Fire Department - 50660
UNIVERSITY OF VIRGINIA HEALTH SYSTEM, MEDICAL TRANSPORT NETWORK - 00125
UPPER LANCASTER VOLUNTEER RESCUE SQUAD - 00284
UVA HEALTH CULPEPER MEDICAL CENTER - 00255
VALLEY MEDICAL TRANSPORT - 00057
VALLEY VOLUNTEER FIRE DEPARTMENT, INC. - 00739
VANGUARD AMBULANCE LLC - 50540
VERONA VOLUNTEER FIRE COMPANY - 00831
VESTA RESCUE SQUAD - 00157
VICTORIA FIRE & RESCUE - 00402
VINTON FIRST AID CREW, INC - 00033
VIRGINIA BEACH DEPARTMENT OF EMS - 00404
VIRGINIA BEACH LIFESAVING - 00612
VIRGINIA BEACH VOLUNTEER RESCUE SQUAD - 00328
VIRGINIA CITY HYBRID ENERGY CENTER EMERGENCY RESPONSE TEAM - 50480
VIRGINIA INTERNATIONAL RACEWAY - 01036
VIRGINIA MEDICAL TRANSPORT, LLC / DBA PHYSICIANS TRANSPORT SERVICE - 50476
VIRGINIA MILITARY INSTITUTE EMERGENCY MEDICAL SERVICES - 01358
VIRGINIA STATE POLICE - MEDFLIGHT I - 00496
VIRGINIA STATE POLICE - MEDFLIGHT II - 00500
VIRGINIA STATE POLICE - OPERATIONAL MEDICAL SUPPORT UNIT - 01322
VIRGINIA TECH RESCUE SQUAD - 00221
VIRGINIA URGENT EMERGENT MEDICAL SUPPORT, PLLC - 01367
WACHAPREAGUE VOLUNTEER FIRE COMPANY - 00355
WALKERS CREEK VOLUNTEER FIRE DEPARTMENT - 00765
WARREN COUNTY DEPARTMENT OF FIRE & RESCUE SERVICES - 00943
WARRENTON TRAINING FIRE DEPARTMENT - 00717
WARRENTON VOLUNTEER FIRE COMPANY - 00830
WASHINGTON COUNTY FIRE/RESCUE - 00699
WASHINGTON COUNTY LIFE SAVING CREW INC - 00209
WASHINGTON VOLUNTEER FIRE & RESCUE - 00099
WAVERLY RESCUE SQUAD - 00303
WAYNESBORO FIRST AID CREW - 00244
WEST HANOVER VOLUNTEER RESCUE SQUAD, INC. - 00491
WEST POINT VOLUNTEER FIRE DEPARTMENT - 00293
WESTERN ALBEMARLE RESCUE SQUAD - 00121
WESTERN-STAR HOSPITAL AUTHORITY INC. / DBA METROHEALTH EMS - 50473
WESTMORELAND COUNTY DEPARTMENT OF EMERGENCY SERVICES - 01274
WESTMORELAND VOLUNTEER FIRE DEPARTMENT - 01267
WESTROCK RESCUE SQUAD - 00409
WEYERS CAVE VOLUNTEER FIRE COMPANY - 00634
WILLIAMSBURG FIRE DEPT - EMS - 00427
WINCHESTER FIRE & RESCUE DEPARTMENT - 00614
WINDSOR VOLUNTEER RESCUE SQUAD - 00311
WINTERGREEN RESCUE SQUAD - 00112
WISE RESCUE SQUAD, INC - 00004
WOODSTOCK VOLUNTEER RESCUE SQUAD - 00065
WYTHEVILLE FIRE RESCUE - 50530
Washington County Emergency Service - 50601
Wegmans Food Markets, INC - 50611
Wythe County Emergency Services - 50649
YOKOHAMA INDUSTRIAL RESCUE SQUAD - 00919
YORK COUNTY FIRE AND LIFE SAFETY - 00338
YORKSHIRE VOLUNTEER FIRE DEPARTMENT - 00085
Required
Agency Number
Drugs Missing From
Supply Storage Area
Vehicle
Other
Required
Drugs Missing Description
0
of
100
Required
Signs of Physical Damage
Yes
No
Required
Describe
0
of
100
Required
Drugs in Locked Cabinet or Box
Yes
No
Other
Required
Other
0
of
100
Required
Type of Security System in Place
Video
Alarm
Other
Required
Other
0
of
100
Required
Date Discovered
Required
Time Discovered
12:00 AM
12:15 AM
12:30 AM
12:45 AM
01:00 AM
01:15 AM
01:30 AM
01:45 AM
02:00 AM
02:15 AM
02:30 AM
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05:45 AM
06:00 AM
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06:45 AM
07:00 AM
07:15 AM
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07:45 AM
08:00 AM
08:15 AM
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08:45 AM
09:00 AM
09:15 AM
09:30 AM
09:45 AM
10:00 AM
10:15 AM
10:30 AM
10:45 AM
11:00 AM
11:15 AM
11:30 AM
11:45 AM
12:00 PM
12:15 PM
12:30 PM
12:45 PM
01:00 PM
01:15 PM
01:30 PM
01:45 PM
02:00 PM
02:15 PM
02:30 PM
02:45 PM
03:00 PM
03:15 PM
03:30 PM
03:45 PM
04:00 PM
04:15 PM
04:30 PM
04:45 PM
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05:30 PM
05:45 PM
06:00 PM
06:15 PM
06:30 PM
06:45 PM
07:00 PM
07:15 PM
07:30 PM
07:45 PM
08:00 PM
08:15 PM
08:30 PM
08:45 PM
09:00 PM
09:15 PM
09:30 PM
09:45 PM
10:00 PM
10:15 PM
10:30 PM
10:45 PM
11:00 PM
11:15 PM
11:30 PM
11:45 PM
Required
Last Date Drugs Were Checked
Required
Diversion Occurred Address Line 1
Required
Diversion Occurred Address Line 2
Diversion Occurred ZIP
Required
Diversion Occurred City
Required
Diversion Occurred State
Required
Discovered Organization Name
Discovered Person First Name
Discovered Person Middle Name
Discovered Person Last Name
Discovered Person Address Line 1
Required
Discovered Person Address Line 2
Discovered Person ZIP
Required
Discovered Person City
Required
Discovered Person State
Required
Primary Phone #
Alternate Phone #
Has Local Law Enforcement Been Contacted
Required
Law Enforcement Agency Name
Required
Investigating Officer First Name
Required
Investigating Officer MI
Investigating Officer Last Name
Required
Investigating Officer Phone#
Was the Drug box returned to a Pharmacy?
Yes
No
Required
Name of the Pharmacy Drug Box was returned to
Required
Date Received
Required
List of the Drugs and Volumes Involved in the Diversion
0
of
3900
Required
Signature
Required
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