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Forms and Publications for EMS
Life Support Agency & Vehicle Licensure Forms
Ambulance Operation Licensing
Application to Operate Basic, Limited, & Advanced Services BHS/EMS-352 (Revision: 3/2006)
Life Support Agency License Application BHS/EMS-180 (Revision: 10/2005)
Life Support Vehicle Application BHS/EMS-181 (Revision: 10/2005)
Certificate of Insurance for Life Support Agencies BHS/EMS-0092 (Revision: 10/2005)
Emergency Medical Services Personnel List BHS/EMS-327 (Revision: 10/2005)
Ambulance Safety Inspection - Certificate of Compliance BHS/EMS-316 (Revision: 8/2005)
Ambulance Safety Inspection BHS/EMS-318 (Revision: 8/2005)
Vehicle Operation Course Criteria BHS/EMS-2007 
Manufacturers Certificate of Compliance BHS/EMS-314 (Revision: 10/2005)
Minimum Required Equipment/Supplies & Agency Criteria
MFR Agency Vehicle Requirements MFR Equipment List (Revision: 2005)
BLS/LALS/ALS Agency Vehicle Requirements BLS/LALS/ALS Equipment List (Revision: 2005)
Required Agency Criteria Agency Criteria (Revision: 1/2006)
Miscellaneous Publications
MEDCOM Requirements MEDCOM (Revision: 9/2006)
Medical Control Authority Directory MCA Directory (Revision: 1/2008)
Personnel Licensure
Licensing
Licensing Application Packet - All Levels EXCEPT INSTRUCTOR COORDINATOR DCH-EMS-250 (Revision: 4/2007)
Relicensure Application Packet (License expired within last 3 years) - All Levels EXCEPT INSTRUCTOR COORDINATOR DCH-EMS-400 (Revision: 4/2007)
Criminal Conviction History Form (Complete and submit with licensure application if applicable) DCH-EMS-002 (Revision: 7/2004)
Instructor Coordinator Exam Reservation Form  IC Exam Reservation Form (Revision: 10/2007)
Instructor Coordinator Exam Schedule 2007-2008 IC Exam Schedule 2007-2008
Instructor Coordinator Application Packet DCH-EMS-500a (Revision: 4/2007)
Instructor Coordinator Relicensure Application Packet (License expired within last 3 years) DCH-EMS-501a (Revision: 4/2007)
Fee Exemption Request Form for Volunteers DCH-EMS-003 (Revision: 12/2006)
Education
Application for Initial Approval (used for initial EMS Education, Instructor-Coordinator Education, and Continuing Education Programs) BHPPA-EMS 136 (Revised: 10/2007) 
Re-Approval Program Application BHPPA-EMS 136b (Revised: 7/2005) 
Interim Course Application BHPPA-EMS 136a (Revised: 10/2007) 
Satellite Location Application BHPPA-EMS 136s (NEW: 2/2006) 
Notification of Change in Program  BHPPA-EMS 136r (NEW: 10/2007)
MFR & EMT Practical Examination Assurance Statement  Assurance Statement (NEW: 9/2007) 
EMS Education Program Sponsor Explanation and Criteria (used for initial EMS Education, Instructor-Coordinator Education, and Continuing Education Programs) Program Sponsor Explanation and Criteria (Revised: 10/2007)
Education Objectives
Medical First Responder MFR Objectives
Basic Emergency Medical Technician BASIC EMT Objectives
Emergency Medical Technician - Specialist EMT-S Objectives
Paramedic Paramedic Objectives
Instructor-Coordinator IC Objectives
General Forms
Course Schedule (Fill-in Format) Course Schedule (Revised: 9/2007) (Microsoft Word)
Course Completion Roster BHPPA-EMS 122 (Revised: 10/2006) (Microsoft Word)
EMT Practical Exam Re-Verification Form (Courses completed prior to 9/1/07) EMT Practical Exam Re-Verification Form (NEW: 9/2007) (Microsoft Excel)
Subject Matter Expert/Qualified Instructor Policy SME & Qualified Instructor Policy (Revised: 6/2005)
Program Approval Packet Samples Program Approval Packet Samples (Revised: 2000)
National Registry Practical Skill Sheets  MFR Skills (ZIP/PDF File Format)
EMT Skills (ZIP/PDF File Format)
Course Audit Sheets MFR
MFR Refresher
EMT Matriculation
EMT
EMT Refresher
EMT-Specialist
EMT-Specialist Refresher
Paramedic
Paramedic Refresher
Instructor-Coordinator
RN to EMT
RN to Paramedic 
Continuing Education
For EMS Personnel & Instructor-Coordinators
Personnel CE Record Form Personnel CE Record Form (Revision: 10/2007)
Instructor-Coordinator CE Record Form IC CE Record Form (Revision: 12/2006)
Sample Attendance Roster for CE Credits CE Attendance Roster (Revision 2/2006)  (Microsoft Word)
Sample Proof of Attendance (CHIT) CHIT Sheet (Revision: 3/2006)
Pre-Approved Standardized CE Credits Standardized CE Credits (Revision: 2/2008)
For EMS Program Sponsors & Instructor-Coordinators 
CE Approval Guidelines CE Approval Guidelines (Revision: 10/2007)
Application for CE Topic  BHPPA-EMS-202 (Revision: 10/2007) 
Application for CE topic(s) not included in initial CE approval BHPPA-EMS-202c (Revision: 2/2006)
General Forms
CE Program Schedule (Fill-in Format) CE Program Schedule (NEW: 9/2007) (Microsoft Word)
Complaints, Allegations, & Enforcement
Allegation/Complaint Form BHS-EMS-200 (Revision 1/2006)