Applications & Forms

Please allow 30 business days for processing.

EMS Personnel License Application
Advanced Life Support Checklist for Pediatric Equipment
Air Ambulance Inspection Checklist
Air Ambulance Service License Application
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
Licensee Change of Address
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


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