EMS Forms and Related Documents

• 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
• Voluntary Surrender of EMS Medic AND/OR EMS Instructor License  

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

• Physician Order For Life-Sustaining Treatment (POLST)
• Waivers and Variances Request Form
• 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