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Emergency Medical Services
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Programs Clinics Permits & Regulations Health Topics News & Information About Us
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Emergency Medical Services and Trauma System

Calendar of Events

Clark County Trauma System

Regional Trauma Advisory Board

Trauma Medical Audit

Trauma Archive

EMS Advisor

Forms

Frequently Asked Questions

Manuals & Regs

Meetings

Meetings Archive

Online Training

Permitted Agencies

Training Centers

 

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Emergency Medical Services
and Trauma System

program contacts
Contact Information
(702) 759-1050
EmergencyMedical
@snhdmail.org
 

Forms

The documents on this webpage are in Portable Document Format (PDF). You will need Acrobat Reader (a free application) to view and print these documents.

New Applicants
Instructions for Reciprocity Applicants PDF (79 KB/1 page)
Instructions for Challenge Applicants PDF (81 KB/1 page)
Application for EMT Certificate and/or Attendant License PDF (75 KB/4 pages)
Instructions for Licensure Applicants PDF (30 KB/2 pages)
Application for Initial Ambulance Permit PDF (39 KB/6 pages)
Application for Authorization/Reauthorization as an EMS Training Center
PDF (133 KB/2 pages)
 
EMS Training Forms
Notice of Intent to Conduct EMS Training Course PDF (31 KB/1 page)
Notice of Intent to Conduct EMS Continuing Medical Education (CME) Training PDF (39 KB/1 page)
EMS Course Completion Record PDF (37 KB/1 page)
Paramedic Didactic/Clinical Course Completion PDF (36 KB/1 page)
 
Recertification Forms
First Responder Recertification Report PDF (25 KB/2 pages)
EMT-Basic Recertification Report PDF (29 KB/2 pages)
EMT-Intermediate Recertification Report PDF (29 KB/2 pages)
EMT-Paramedic Recertification Report PDF (32 KB/2 pages)
EMS Instructor Renewal Report PDF (20 KB/1 page)
Skills Proficiency Record PDF (49 KB/2 pages)
Application for Renewal of EMS Certification PDF (76 KB/2 pages)
Application for Renewal of Ambulance Permit PDF (45 KB/6 pages)
 
EMS Instructor/RN/PA Forms
Application for EMS Instructor Certification PDF (43 KB/2 pages)
Monitoring Form for EMS Instructor Applicant PDF (25 KB/1 page)
Physician Advisor Verification of EMS Registered Nurse PDF (70 KB/2 pages)
Physician Advisor Verification of Physician’s Assistant PDF (70 KB/2 pages)
 
Do Not Resuscitate (DNR) Forms
DNR I.D. and Information for Pre-Hospital EMS Personnel PDF (90 KB/2 pages)
DNR Application & Instructions for Adults PDF (123 KB/2 pages)
DNR Application & Instructions for Adults (Spanish) PDF (123 KB/2 pages)
DNR Application & Instructions for Minors PDF (121 KB/2 pages)
DNR Application & Instructions for Minors (Spanish) PDF (120 KB/2 pages)
 
Other Forms
Exemplary Performance Recognition PDF (17 KB/1 page)
Petition for New Drug/Equipment PDF (21 KB/5 pages)
Protocol Deviation PDF (54 KB/1 page)
Submersion Incident Report PDF (61 KB/1 page)

 
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