Individual Licensure Information
Provider Licensure Information
- Provider Application - All plans and proof of liability insurance must accompany the application.
Online EMS Provider Licensure Application - The electronic renewal process is now active.
Provider Electronic Patient Care Report Agreement - Please make sure you submit this agreement with your application.
EMS Web Management Form - Please make sure you submit this form with your application.
EMS Provider Licensure Application - This form is fillable and should be typewritten, not handwritten.
Bio-Hazardous Waste Plan Checklist
Controlled Substance Plan Checklist
EMD Plan Checklist
I.V. Fluid/Drug Plan Checklist
Additional Licensure Information
Last Updated: August 18, 2014