Applications & Forms
The following applications/forms pdfs have been removed from the Bureau of Emergency Medical Services website and are now located in the service agency portals. You must have the correct permissions for your agency to access the forms or applications. If you do not have access in your portal to these forms please contact the Bureau so that the correct permissions can be assigned to you.
Image Trend Online License Management System
- Air Ambulance Service License Application
- Emergency Medical Response Agency License Application
- Ground Ambulance Service License Application
- Stretcher Van Application
- Training Entity Accreditation Application
- Change of Manager/Program Director Form
- Change of Medical Director Form
Please allow 30 business days for processing.
- Advanced Life Support Checklist for Pediatric Equipment
- Affidavit
- Air Ambulance Inspection Checklist
- Basic Life Support Checklist for Pediatric Equipment
- Communicable Disease Exposure Report
- EMRA Inspection Checklist
- Fingerprinting MSHP Form for Initial Licensure
- Ground Ambulance Inspection Checklist
- 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)