DPH: OEMS Forms

OEMS Forms



Investigations                                                                                                                                       
Form to submit a complaint regarding quality of care, fraudulent credentials or other misconduct by a healthcare provider.  If you prefer to have this form mailed to you, please call 860-509-7975.
 
 
EMS Instructor Course Forms                                                                                             
Forms for EMS Instructors and EMS Instructor Trainers applying to conduct training courses.

For Initial Certification Training Programs:
 
For Recertification Training Programs:
 
 
 
 
 

EMS Provider Candidate Licensing & Certification Forms                                      
We have recently redesigned our website to put all EMS provider candidate information in one place.  Please visit our Licensing & Certification page for more information, including applications for certification, for all clinical providers.
 
 

EMS Organization Forms                                                                                                             

Forms for organizations to apply for new or expanded services, PSAR designation, change in authorization, new vehicles, change in sponsor hospital, or to add authorized skills. 


BLS Skills and MIC Signature Page {pdf file}
  
Other forms                                                                                                                                       
      

 
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Please Note: Some files are in Portable Document Format (pdf). You will need Adobe Acrobat Reader to view and print the information. For fillable pdf forms, you must download and save the form to your computer for the full functionalities to work.   Other files are in Microsoft Word or Excel Format (.doc or .xls).  You will need Microsoft Word and/or Excel Viewers to view and print this information.

               {Get Adobe Acrobat Reader}                         



Content Last Modified on 10/4/2017 11:39:46 AM