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

• Application for Community Paramedic Services Endorsement 08/06/2018
• Application for Rural Volunteer Ambulance Driver 08/27/2018
• Instructions for Licensure Applicants (temporarily unavailable)
• Instructions for Initial Certification Applicants (temporarily unavailable)
• Physician’s Statement 01/09/2019
• Request for Verification of Certification 09/27/2017

Do-Not-Resuscitate DNR/POLST Forms

• DNR I.D. & Information for Pre-Hospital EMS Personnel 12/29/2016
• DNR Application & Instructions for Adults 12/29/2016
• DNR Application & Instructions for Adults Spanish 11/27/2013
• DNR Application & Instructions for Minors 12/29/2016
• DNR Application & Instructions for Minors Spanish 11/27/2013
• 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 07/10/2018
• Monitoring Form for EMS Instructor Applicant 11/25/2020 NEW
• 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 07/12/2019
• SNHD Paramedic Mentorship/Internship Program 03/18/2019

Recertification Forms

• AEMT Recertification Report 11/14/2017
• Critical Care Paramedic Renewal Report 01/21/2016
• EMT Recertification Report 11/14/2017
• EMS Instructor Renewal Report 11/27/2013
• Paramedic Recertification Report 11/14/2017

Skills

• Skills Proficiency Record 12/28/2018
• 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

• AMA Form 11/26/2014
• Ambulance Inspection Form 07/01/2019
• 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 03/24/2016
• Official EMT/AEMT Drug Inventory 08/01/2018
• Official Paramedic Drug Inventory 07/01/2019
• Petition for New Drug/Equipment 05/18/2010
• Protocol Deviation 11/27/2013
• Submersion Incident Report 11/27/2013