Service Provider Certifications Forms and Information
If you have questions regarding rules, equipment or standards while filling out the applications, please refer to the Title 836 rules found at EMS Rules and Laws.
Emergency Vehicle Equipment Checklist-General
This checklist includes all of the mandated equipment to be carried on BLS and ALS vehicles. Please have ready only the equipment pertaining to your level of service.
Air Ambulance Provider
Applications
- Inital & Renewal Application
- Aircraft Application for Certification
- Staff roster (also needs to be signed by Medical Director)
Medical Director Approval Form
Information
ALS Provider - Transport & Non-transport
Applications
- Initial - ALS Service Provider Application (new or upgrading service)
- Renewal Application
- Staff roster (also needs to be signed by Medical Director)
Medical Director Approval Form
Information
BLS Ambulance Provider
Applications
- Initial - BLS Service Provider Application (new or upgrading service)
- Renewal Application
- Staff Roster (also needs to be signed by Medical Director)
Medical Director Approval Form
BLS Non-transport Provider
Applications
- Initial - BLS Service Provider Application
- Renewal Application
- Staff roster (also needs to be signed by Medical Director)
Medical Director Approval Form
Information
Supervising Hospital
Applications
- Inital & Renewal Application
- Staff roster (also needs to be signed by Medical Director)
Note: On Section E, "approval of medical staff" means the CMO or Chief of Staff, NOT the service or ED Medical Director.
Vehicle Certification & Other Forms
- New or Replacement Vehicle Application
- Vehicle Proof of Insurance Form
- Vehicle Accident Reporting Form