Applications & Forms

Please allow 30 business days for processsing.

EMS Personnel License Application
Advanced Life Support Checklist for Pediatric Equipment
Affidavit
Air Ambulance Inspection Checklist
Air Ambulance Service License Application
Ambulance Service End of Year Report
Basic Life Support Checklist for Pedatric Equipment
Change of Manager
Change of Medical Director
Communicable Disease Exposure Report
EMRA Inspection Checklist
Emergency Medical Response Agency License Application
Ground Ambulance Inspection Checklist
Ground Ambulance Service License Application - - - Map
Voluntary Surrender of EMS License

Outside the Hospital Do-Not-Resuscitate Order

Approved Medallion Vendor Contact Information
Authorization Form (black/white) Authorization Form (purple)
Definitions of Key Terms (black/white) Definitions of Key Terms (purple)
Frequently Asked Questions
Identification Card (black/white) Identification Card (purple)

Stretcher Vans

Stretcher Van Application
Stretcher Van Inspection Checklist

Trauma

Application for Trauma Center Review and Designation
Level I Trauma Center Checklist
Level II Trauma Center Checklist
Level III Trauma Center Checklist

Training

Training Entity Accreditation Application
Training Entity Accreditation Inspection Checklist
Training Program Annual Report
Training Entity EMT-B Skills Verification
Training Entity FR Checklist