Emergency Medical Services

• Certification (Out-of-State)
• EMT Certification Waiver
• Recertification
• Discrepancy Report Forms
• Instructor and Examiner Applications
• Continuing Education
• Ambulance Services
• Service Zone Forms
• Training Institution Accreditation

Certification (Out-of-State)

EMT Basic

• EMT Basic Certification Procedures Based on Out-of-State/Other Licensure or Certification (PDF) | RTF

• Application, including instructions, Updated 9/2009 (PDF) | RTF

• Verification of Emergency Medical Technician Status (PDF) | RTF

• EMT Basic Certification Procedures Based on Out-of-state Training (PDF) | RTF

EMT Intermediate

• EMT Intermediate Certification Procedures Based on Out-of-State Training, Licensure or Certification (PDF) | RTF

• Application, including instructions, 9/2009 (PDF) | RTF

• Verification of Emergency Medical Technicians, 9/2009 (PDF) | RTF

EMT Paramedic

• EMT Paramedic Certification Procedures Based on Out-of-state Training, Licensure or Certification (PDF) | RTF

• Application, including instructions, 9/2009 (PDF) | RTF

• Verification of Emergency Medical Technicians, 9/2009 (PDF) | RTF

EMT Certification Waiver

• Form 500-201, Temporary 90-Day Waiver of EMT Certification Requirements, 8/2002 (PDF) | RTF

• Form 500-202, Temporary Waiver of EMT Certification Requirements (PDF) | RTF

Recertification

• Form 300-1, EMT BASIC Recertification Application, Updated 9/2009 (PDF) | RTF

• Form 300-3, ADVANCED EMT Recertification Application for Intermediate and Paramedic Recertifications, Updated 9/2009 (PDF) | RTF

• EMT Change of Address and Request Form, 4/5/2005 (PDF) | RTF

Discrepancy Report Forms

• Basic Emergency Medical Technician, Updated 9/2009 (PDF) | RTF

• Advanced Emergency Medical Technician, Updated 9/2009 (PDF) | RTF

Instructor and Examiner Applications

• EMT Continuing Education Training Program Application (PDF) | RTF

• Forms 200-10, 200-11, 200-11a, EMT-BASIC Instructor/Coordinator Application Package, 11/2003 (PDF) | RTF

• Form 200-24, Basic Examiner Application, 11/2003 (PDF) | RTF

• Form 300-24, Advanced Examiner Application (PDF) | RTF

Continuing Education

• EMT Refresher and Continuing Education Training Manual (PDF) | RTF 2.59MB

• EMT Continuing Education Training Application and Instructions(PDF) | RTF

• Form 200-59, Official OEMS Attendance Roster (PDF) | RTF

Ambulance Services

• Ambulance Regulation Program Plan of Correction (PDF) | RTF

• Ambulance Services Division of Food and Drugs' Controlled Substance Registration Application (PDF) | RTF

• Serious Incidents or Accidents Report Form, Updated 8/28/2009 (PDF) | RTF

• Unprotected Exposure Form, 5/26/2004 (PDF) | RTF

• Ambulance Service License Application Instructions (see Parts A, B, C, D, E, F, and H) (PDF) | RTF

• Complete Ambulance Service License Application (All Parts) (PDF) | RTF 1MB

  • Part A: Ambulance Service License Application, 8/18/2009 (PDF) | RTF

  • Part B-1 and B-2: Ambulance Service Area (PDF) | RTF

  • Part C: Ambulance EMS Personnel List (PDF) | RTF

  • Part D: Ambulance Service Place of Business (PDF) | RTF

  • Part E: Ambulance Vehicle Certification, 8/18/2009 (PDF) | RTF

  • Part F: Ambulance Staffing Waiver Utilization (PDF) | RTF

  • Part H: Ambulance Affiliation Agreement Review Checklist (PDF) | RTF

  • EMT Certification Waiver

  • Faxable Complaint Reporting Form (PDF) | RTF

Service Zone Forms

• List of Local Jurisdictions Covered by a DPH-Approved Service Zone Plan, November 9, 2009 (PDF) | RTF

• Current Service Zone Plan Application, April 3, 2007 (PDF) | RTF 1.29MB

• Original Service Zone Application, Cover Letter to Chief Municipal Officers, August 17, 2004 (PDF) | RTF

• Response Times and Service Zone Planning, April 18, 2006 (PDF) | RTF

Training Institution Accreditation

• Application for Accreditation for Initial EMT Training Institution (Full Application), 7/27/2005 (PDF) | Word
• Accreditation Renewal Application Cover Letter to Program Directors, 2/14/2008 (PDF) | RTF
• Section I  of Accreditation Renewal Application, 2/14/2008 (PDF) | RTF
• Section II of Accreditation Renewal Application, 2/14/2008 (PDF) | RTF
• Section III of Accreditation Renewal Application - Questionnaire to be completed by Current Students, 2/14/2008 (PDF) | RTF