Apply to operate a Community EMS Program

The Community EMS (CEMS) application form must be completed by a local public health authority (such as a board of health) in partnership with the primary ambulance service in the local jurisdiction where the proposed Community EMS Program will operate.

During the application process, please use the guidance information and documentation to help craft your program and application:

• MIH and Community EMS applicant and program guidance
• Approved Community EMS services
• MIH and Community EMS Regulations

Please note, if you wish to apply to operate either Mobile Integrated Health or Mobile Integrated Health with ED Avoidance program, there are separate applications on their respective webpages.

Application Requirements

Applicants may only apply to become a Community EMS program proposing services that are included in the Defined List of Community EMS Program Services. Applicants who wish to propose adding a service to the Defined List of Community EMS Program Services must submit a petition form to DPH for consideration.

A complete Community EMS application includes:

• Completed Community EMS Application Form (PDF) | (DOCX), including all required attachments, descriptions, and narratives
  • Instructions to create an electronic signature
• Letter of support from the authorized signatory of the local jurisdiction, if signature on the application could not be completed (submission should be on official letterhead of jurisdiction)

Next steps

Application Review

Applications will be reviewed in the order they are received. Once a completed application is received, DPH will review the information and will contact the applicant if clarifications or additional information for the submitted application materials are needed.

DPH will issue program approval within 30 days of receipt of the completed application. Please note that an application will be considered “complete” once all required documents have been received by DPH.