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 in the EMS Rules and Laws section (within the Resources and Data section) on the Emergency Medical Services page.
ALS and BLS Provider Forms
- 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.
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 Forms
Information
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 Forms
Applications
- Initial - BLS Service Provider Application
- Renewal Application
- Staff Roster (also needs to be signed by medical director)
Medical Director Approval Forms
Information
Miscellaneous Provider Forms
Applications
- Initial and Renewal Application
- Aircraft Application for Certification
- Staff Roster (also needs to be signed by medical director)
Medical Director Approval Form
Information
Applications
- Initial and 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.