EMS Forms and Related Documents

Click on the section for the forms you are looking for.

Forms for EMS Personnel
- Fingerprint Background Instructions Only - GA Residents
- Fingerprint Background Instructions Only - Out-of-State Residents
- Out-of-State Verification Form (This form must be completed for EACH state/territory/region where an applicant holds a healthcare license/certification.)
- C-09-A Voluntary Surrender Form
- Verification of Lawful U.S. Residency Form
- List of Acceptable Secure and Verifiable Documents
- Support Letter for NREMT Pathways for Registration
EMS Agency Forms for the License Management System (LMS)
Vehicle Inspection Forms
Forms Related to EMS Initial Education Programs
- T-04-A EMS Education Program Application
- Initial Education File Review Forms - updated 4/22/2020 for COVID-19
  - EMT
  - AEMT
  - Paramedic
- EMT Psychomotor Exam Report
- Psychomotor Exam Skills Verification Sheets - EMR | EMT
- Family Educational Rights and Privacy Act (FERPA) Form
Specialty Designation Information
- Remote Treatment Stroke Center Application
Miscellaneous Forms

Current EMS Agency Renewal Application

All EMS Agencies must now (as of 3/1/2020) complete a full EMS Agency Renewal application online. Authorized Agents for each EMS agency will receive emails regarding the instructions.
All ambulance service licenses must be renewed every two years, and renewal notices are emailed to Authorized Agents by the Georgia EMS License Management System.

For information regarding EMS Procedures, Forms and Related Documents contact the State Office of EMS at 770-996-3133 or your Regional EMS Office.

Page last updated 12/18/2020

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