EMS Forms
Please go to the EMS Portal if you are applying for the following:
- Certification/Recertification
- Licensure
- Instructor endorsement/Renewal of endorsement
- CCT Paramedic endorsement/Renewal of endorsement
- EMS-RN
- Initial Ambulance Permit/Renewal of Ambulance Permit
- Training Center Authorization/Reauthorization
Training Center Course Coordinators: Please go to ImageTrend to submit the Notice of Intent to Conduct EMS Training for approval by the OEMSTS.
New Applicants
- Under Construction
Do-Not-Resuscitate DNR/POLST Forms
- DNR I.D. & Information for Pre-Hospital EMS Personnel 12/29/2016
- DNR Application & Instructions for Adults 09/27/2023
- DNR Application & Instructions for Adults Spanish 09/27/2023
- DNR Application & Instructions for Minors 09/27/2023
- DNR Application & Instructions for Minors Spanish 09/27/2023
- Physician Order for Life-Sustaining Treatment 12/2013
(This form is free of charge)
Drug Shortage Guidance
- District Procedure for Managing Drug Shortages 03/19/2014
- Drug Shortage Guidance Letter 03/19/2014
- Temporary Drug Inventory 01/22/2014
EMS Instructor/RN/PA Forms
- EMS-RN Checklist 11/13/2023
- Monitoring Form for EMS Instructor Applicant 02/27/2023
- Physician Advisor Verification of EMS Registered Nurse 03/05/2015
- Physician Advisor Verification of Physician Assistant 06/04/2012
EMS Training Forms
- EMS Course Completion Record 10/25/2022
- SNHD Paramedic Mentorship/Internship Program 2023
- EMS Course Evaluation 03/02/2020
- Paramedic Clinical/Didactic Course Completion 10/25/2022
Recertification Forms
- AEMT Recertification Report 02/27/2023
- Critical Care Paramedic Renewal Report 01/21/2016
- EMT Recertification Report 02/27/2023
- EMS Instructor Renewal Report 11/27/2013
- Paramedic Recertification Report 02/27/2023
Skills
- Skills Proficiency Record 10/25/2022
- National Registry EMT Practical Examination Report Form 07/01/2019
- Physician Advisor Verification of Critical Care Paramedic Skills 08/16/2018
- Physician Advisor Verification of Physician Assistant Skills 08/16/2018
- Physician Advisor Verification of EMS Registered Nurse Skills 08/16/2018
Other Forms
- Trauma Renewal Application 01/03/2024
- EMS Vehicle Collision Report 12/18/2023
- AMA Form 11/26/2014
- Application for Initial/Renewal Designation as an EMS Pediatric Destination Hospital 01/21/2014
- Exemplary Performance Recognition 11/27/2014
- Incident Report Form
- Official Air Ambulance, Ground Ambulance, and Firefighting Agency Inventory 05/04/2023
- Official EMT/AEMT Drug Inventory 06/07/2023
- Official Paramedic Drug Inventory 12/20/2023
- Petition for New Drug/Equipment 11/09/2020
- Physician’s Statement 10/05/2022
- Protocol Deviation 07/13/2021
- Submersion Incident Report 08/03/2021
Contact Information
Phone: (702) 759-1050
Email: ems@snhd.org
Location & Hours
280 S. Decatur Blvd.
Monday – Thursday
8 a.m. – 4:30 p.m.
Protocol Testing:
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Updated on: January 3, 2024