EMS Forms and Resource Documents

EMS State License Application (Initial application for both In-State and Out-of-State applicants)
Fingerprint Background Process Instructions
Individual License Renewal Application (not available for new applicants)
C-09-A Voluntary Surrender Form
Personnel Information Change Form
Verification of Lawful U.S. Residency Form
Arrest or Criminal Charge Form
Support Letter for NREMT Pathways for Registration

New Ambulance Service License Application

EMS Service License Application Packet (GA EMS 1000)

Vehicle Inspection Forms

R-E-01-A Vehicle Inspection Form - Ground Ambulance
R-E-01-B Vehicle Inspection Form - Neonatal Ambulance
R-E-01-C Vehicle Inspection Form - Medical First Responder
R-E-01-D Vehicle Inspection Form - Air Ambulance

Current Ambulance Service Renewal Application

EMS Service License Renewal Application Packet (GA EMS 1000)

Current Ambulance Service Revision Forms

Use the following revision forms to update insurance, add or delete locations, vehicles and EMS personnel. 

Update Insurance Information - Schedule A
Add/Delete Base Locations
Add/Delete Licensed EMS Personnel - Schedule E
Add/Delete Ambulance Vehicles - Schedule F

For other revisions please complete them on the EMS Service License Application Packet (GA EMS 1000) be sure to mark "Revision" on the application.

C-11-A Initial EMS Instructor Application
T-04-A EMS Education Program Application
T-05-A Medical Director Request Form for ConEd Approval
T-05-B Non-Medical Director Request Form for ConEd Approval
Initial Education File Review Forms - EMT | AEMT | Paramedic 

Notification of Non-Compliance
Physician Order For Life-Sustaining Treatment (POLST)
Waivers and Variances Request Form
Form W-9 - Request for Taxpayer Identification Number and Certification