EMS Forms and Related Documents

•   Fingerprint Background Instructions Only  - GA Residents
•   List of Acceptable Secure and Verifiable Documents
•   Out-of-State Verification Form  (This form must be completed for EACH state/territory/region where an applicant holds a healthcare license/certification.)
•   Support Letter for NREMT Pathways for Registration
•   Voluntary Surrender of EMS Medic AND/OR EMS Instructor License  
•   Verification of Lawful U.S. Residency Form
•   Waiver Request Form  

•   Authorized Agent Certification
•   EMS Agency Admin Certification
•   EMS Agency Variance Request Form
•   List of Acceptable Secure and Verifiable Documents
•   Medical Director Agreement Form
•   Pharmacy Agreement Form
•   Verification of Lawful U.S. Residency Form
•   Voluntary Surrender of EMS Agency License  

The following vehicle inspection forms will be effective starting January 1, 2023. 

•   01.01.2023 Ground Ambulance - Vehicle Inspection Form
•   01.01.2023 Neonatal Ambulance - Vehicle Inspection Form
•   01.01.2023 Medical First Responder - Vehicle Inspection Form
•   01.01.2023 Air Ambulance - Vehicle Inspection Form  

 

•   Remote Treatment Stroke Center Application

•   Form W-9 - Request for Taxpayer Identification Number and Certification
•   Form to Request a Hospital Name Change in the Georgia Office of EMS and Trauma Systems
•   Identify, Isolate, and Inform Guidelines
•   Physician Order For Life-Sustaining Treatment (POLST)