EMS Forms and Resource Documents


For information regarding EMS Procedures, Forms and Resource Documents contact the State Office of EMS at (404) 679-0547 or your Regional EMS Office.

Forms Related to Medics

EMS State License Application (Both for 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 Residency for License Application
NREMT Re-Entry Support Letter
NREMT Physicians Challenging the EMTs/AEMTs/Paramedic Training Programs Support Letter
NREMT Registered Nurses Challenging the EMTs/AEMTs/Paramedic Training Programs Support Letter
Arrest or Criminal Charge Form

Forms Related to Services - Corporations and LLCs Only

EMS License Application for Corporations and LLCs
Licensed EMS Personnel Information - Supplemental Form A
Vehicle Schedule - Supplemental Form B
R-E-01-A Vehicle Inspection Form - Ground Ambulance
R-E-01-B Vehicle Inspection Form - Neonatal Ambulance
R-E-01-D Vehicle Inspection Form - Air Ambulance
Instructions for Group Renewals

Forms Related to Services - All Other Services

Emergency Medical Services Licensure Form (GA EMS 1000) 
Addendum A: Insurance Information
Addendum E: Personnel Information
Addendum F: Vehicle Information
GA EMS 1000 Supplemental Form
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
Instructions for Group Renewals

Forms Related to Education

C-11-A EMS Instructor Application
C-11-B EMS Instructor License Renewal Form
T-04-A EMS Education Program Application
Service Medical Director Approved ConEd Request Form
All Other ConEd Request Form 

Specialty Designation Information

Remote Treatment Stroke Center Application

Miscellaneous Forms

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
 

 

 

 

 

 

 


Page last updated 2/20/17