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)    
• Application, including instructions, 9/2010 (PDF)    
• Verification of Emergency Medical Technician Status (PDF)    
• EMT Basic Certification Procedures Based on Out-of-state Training (PDF)    

EMT Intermediate

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

• Application, including instructions, 9/2010 (PDF)    
• Verification of Emergency Medical Technicians (PDF)    

EMT Paramedic

• EMT Paramedic Certification Procedures Based on Out-of-state Training, Licensure or Certification (PDF)    
• Application, including instructions, 9/2010 (PDF)    
• Verification of Emergency Medical Technicians (PDF)    

EMT Certification Waiver

• Form 500-201, Temporary 90-Day Waiver of EMT Certification Requirements (PDF)    
• Form 500-202, Temporary Waiver of EMT Certification Requirements (PDF)    

Recertification

• Form 300-1, EMT BASIC Recertification Application (PDF)    
• Form 300-3, ADVANCED EMT Recertification Application for Intermediate and Paramedic Recertifications (PDF)    
• EMT Change of Address and Request Form (PDF)    

Discrepancy Report Forms

• Basic Emergency Medical Technician (PDF)    
• Advanced Emergency Medical Technician (PDF)    

Instructor and Examiner Applications

• EMT Continuing Education Training Program Application (PDF)    
• Forms 200-10, 200-11, 200-11a, EMT-BASIC Instructor/Coordinator Application Package (PDF)    
• Form 200-24, Basic Examiner Application, 9/2010 (PDF)    
• Form 300-24, Advanced Examiner Application, 9/2010 (PDF)    

Continuing Education

• EMT Refresher and Continuing Education Training Manual (PDF)    
• EMT Continuing Education Training Application and Instructions - In State (PDF)    
• EMT Continuing Education Training Application and Instructions - Out of State (PDF)    
• Form 200-59, Official OEMS Attendance Roster (PDF)    

Ambulance Services

• Massachusetts Medical Orders for Life-Sustaining Treatment (MOLST)
• Ambulance Regulation Program Plan of Correction (PDF)    
• Ambulance Services Division of Food and Drugs' Controlled Substance Registration Application (PDF)    
• Serious Incidents or Accidents Report Form (PDF)    
• Unprotected Exposure Form (PDF)    
• Ambulance Service License Application Instructions (see Parts A, B, C, D, E, F, and H) (PDF)    
• Complete Ambulance Service License Application (All Parts) (PDF)    
  • Part A: Ambulance Service License Application (PDF)    
  • Part B-1 and B-2: Ambulance Service Area (PDF)    
  • Part C: Ambulance EMS Personnel List (PDF)    
  • Part D: Ambulance Service Place of Business (PDF)    
  • Part E: Ambulance Vehicle Certification (PDF)    
  • Part F: Ambulance Affiliation Agreement Review Checklist, 9/2010 (PDF)    
• EMT Certification Waiver
• Faxable Complaint Reporting Form (PDF)    

Service Zone Forms

• Current List of Local Jurisdictions with Department-approved EMS Service Zone Plans, 12/2/2011     
• Current Service Zone Plan Application (PDF)    
• Original Service Zone Application, Cover Letter to Chief Municipal Officers (PDF)    
• Response Times and Service Zone Planning (PDF)    

Training Institution Accreditation

• Accredited Training Institution Continuing Education and Refresher Training Registration Form (PDF)    
• Application for Accreditation for Initial EMT Training Institution (Full Application) (PDF)    
• Accreditation Renewal Application Cover Letter to Program Directors (PDF)    
• Section I of Accreditation Renewal Application (PDF)    
• Section II of Accreditation Renewal Application (PDF)    
• Section III of Accreditation Renewal Application - Questionnaire to be completed by Current Students (PDF)    

 

---

This information is provided by the Office of Emergency Medical Services within the Department of Public Health.