Licensure Forms

• Online EMS Certification Verification
• CCT Checklist from PA Bulletin 5
• IALS Checklist-PA Bulletin

Regional EMS Services

• ALS Ambulance 09-01-2019 
• BLS Ambulance 09-01-2019
• IALS Ambulance 09-01-2019
• ALS SQUAD 09-01-2019
• BLS SQUAD 09-01-2019
• CCT Ambulance 09-01-2019
• IALS Squad 09-01-2019
• QRS Agency 09-01-2019
• Air Ambulance 09-01-2019
• Reserve Ambulance Checklist 10/01/2019
• Station Checklist 10/01/2019
• Temporary Replacement Vehicle Form 12/8/2022
• Testing Portable & On Board Suction Units
• CLIA FAQ and Waiver Form
• Overview of the Ambulance Service Licensure Program
• SAMPLE Licensure Policies
• PSAP Reporting forms A & B
• List of Approved Emergency Vehicle Operator Courses July 1 2009
• Request for an Exception
• Application for VRSR 2008
• VRSR – General Administrative Guide March 2009
• VRSR – Vehicle and Machinery Rescue March 2009
• VRSR – Swiftwater Rescue and Flood Evacuation March 2009
• Epi Pen DOH Approved Process
• Epi Pen Reconciliation Form
• Epi Pen Personnel Roster
• Epi Pen Training Requirements
• Epi Pen Training Policy
• Memo on Reconciliation Requirements
• Medical Directors Agreement 10/22/15
• Sample ALS Authorization Form FY 2013

Medical Facility Forms

• Medical Command Form
• Ambulance to Hospital Radio Form

Mailing Addresses

• ALS/BLS Service Mailing Addresses
• QRS Service Mailing Addresses

AED Forms

• AED Personnel Roster

CPAP Forms

• CPAP for BLS Training Module
• Protocol 226 & 421
• EMS Informational Bulletin #60
• Approved Personnel Roster for CPAP, Epi-pen, and Pulse O