**Evaluate this session**
EMS and Fire systems spend considerable resources emphasizing the importance of documentation, something that’s important not only for assuring quality patient care and navigating potential medicolegal issues, but also for tracking controlled substance use and ensuring appropriate billing reimbursement. Many of us have processes in place for reviewing the adequacy of documentation that is available, but we may have no means to detect when that documentation is missing. A substantial number of calls may be lost to inappropriate cancellations and refusals and, while our controlled substance tracking processes may account for what goes in and out of the office, they may tell us little about what actually happens with these drugs once they are out in the field. This session will analyze one system’s solutions for tracking undocumented calls that would otherwise remain unrecognized by system executives, managers, legal counsel, compliance officers, and medical directors. It will highlight the clinical, legal, regulatory, financial and ethical implications of failing to do so, and provide a methodology for effective tracking and monitoring of controlled substance utilization.