EMS Forms and Documents

Education

• Continuing Education Application-DH Form 1698C (Editable Version)
• Application for Approval of an EMS Training Program-DH Form 1698, December 2008 (Editable Version)
• CPR/ACLS Equivalent Application-DH Form 1938, February 2002 (Editable Version)

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EMS Service Provider Licensing

• Ground Ambulance Service Provider Licensure Application-DH Form 631
• Air Ambulance Service Provider Licensure Application-DH Form 1575
• Application for Vehicle Permit(s)-DH Form 1510
• Application for Air Ambulance Permit-DH Form 1576, April 2009

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EMS for Children

• Student Injury Report Form
• Interfacility Transfer Guidelines Toolkit and Form Template

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EMS Inspections

• Inspection Corrective Action Form
• Inspection Narrative Form
• Air Ambulance Inspection Report Form
• Neonatal Interfacility Vehicle Inspection Form
• Equipment Test Results
• ALS Vehicle Inspection Form
• BLS Vehicle Inspection Form
• Service Records and Facilities Inspection Form
• Personnel Records

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Miscellaneous Forms and Documents

• Public Records Exemption Request
• Stroke Assessment Tool
• EMS Course Completion Roster
• AHCA Stroke Center List
• Comprehensive Stroke Center with 45-Minute Drive Time Analysis
• Certification of Training-DH Form 1256, December 2008