- CORI
- Certification (Out-of-State)
- EMT Certification Waiver
- Recertification
- Reinstatement
- Discrepancy Report Forms
- Instructor and Examiner Applications
- Continuing Education
- Ambulance Services
- Service Zone Forms
- Training Institution Accreditation
CORI
- Updated Criminal Offender Record Information (CORI) Acknowledgment Form, 8/3/2012
(complete form and submit along with copy of government-issued photo ID, such as driver’s license or U.S. passport)
Certification (Out-of-State)
EMT Basic
- A/R 2-236 EMT- BASIC Certification Procedures Based on Out-Of-State Licensure/ Certification or Other Massachusetts Licensure/Registration
- Application, including instructions
- Verification of Emergency Medical Technician Status
- A/R 2-237 EMT- BASIC Certification Procedures Based on Out-Of-State Training
EMT Intermediate
EMT Paramedic
- A/R 2-323B EMT-Paramedic Certification Procedures Based on Out-Of-State Training, Licensure or Certification
- Application, including instructions
- Verification of Emergency Medical Technician Status
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
- Form 300-3, ADVANCED EMT Recertification Application for Intermediate and Paramedic Recertifications
- EMT Change of Address and Request Form (PDF)
Reinstatement
- A/R 2-248 Recertification Deadlines and Reinstatement Procedures for EMT-Basics Expiring 4/1/2013
- A/R 2-353 Recertification Deadlines and Reinstatement Procedures for EMT-Intermediates and EMT-Paramedics Expiring 4/1/2013
- EMT Reinstatement Application Form
Discrepancy Report Forms
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)
file size 2MB
- 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
- 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 Incident Report Form
- 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)
file size 2MB
- 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)
file size 1MB
- Part A: Ambulance Service License Application (PDF)
- EMT Certification Waiver
- Faxable Complaint Reporting Form (PDF)
Service Zone Forms
- Current List of Local Jurisdictions with Department-approved EMS Service Zone Plans - 5/20/2013
- Current Service Zone Plan Application (PDF)
file size 1MB
- 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)
- 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.