Applications & Forms
Please allow 30 business days for processing.
- Advanced Life Support Checklist for Pediatric Equipment
- Affidavit
- 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
- Fingerprinting MSHP Form for Initial Licensure
- 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)