EMS Agency Licensure

Step 1: Email Diane Strickland ([email protected]) that you are requesting to be able to submit an application for a new EMS agency. You will need to provide the following information:

• Desired Agency Name (the requested name must not be substantially similar to an existing EMS agency name)
• Username in the EMS License Management System of the Authorized Agent

NOTE: If the Authorized Agent for the new agency is a Georgia licensed medic, then you already have an account in the system. For Authorized Agents who have never been licensed as a medic in the state of Georgia, you will need to create an account. For information on how to find your username if you are a licensed medic or on how to create an account, click HERE.

Step 2: After we create the entity in our system and assign the above person as the Authorized Agent of the agency, the Authorized Agent will get an email from "[email protected]" that they have been added as an Authorized Agent.

• A completed and notarized Authorized Agent Designation form (Click  HERE  ) for each Authorized Agent
• A completed and notarized Verification of Lawful U.S. Residency form (Click  HERE ) for each Authorized Agent
• A clear scanned copy of the secure and verifiable document that was shown to the notary public for each Authorized Agent (Click HERE for a list of acceptable documents)
• For Corporations - a scanned copy of the Articles of Corporation
• For LLCs - a scanned copy of the Articles of Organization

• A scanned and signed copy of the complete Service Delivery Contract

Agencies must designate the following at a minimum, and all must have an account in the Georgia EMS License Management System:

• ONE (1) Service Director (Person with ultimate responsibility within the service)
• ONE (1) Training Officer (Person whose primary role is training individuals within the service)
• ONE (1) Data Manager (Person who is responsible for GEMSIS data reporting validation and accuracy)
• ONE (1) Infection Control Officer (Person responsible for infectious disease control plan and procedures)
• ONE (1) Pediatric Emergency Care Coordinator (for 911 agencies) (Person responsible for coordinating pediatric-specific activities)
• ONE (1) Communications Officer (Person responsible for communication log or dispatch center)

All EMS Agencies that do not use a complete Service Delivery Contract must have a current Georgia License Physician (MD, DO) as their designated Medical Director, and each Medical Director must have the following form completed:

• Completed Medical Director Agreement Form (Click  HERE  )

A Pharmacy is also required for EMS Agencies that will have any medications or IV fluids, and the Pharmacy and Pharmacist must be currently licensed in the State of Georgia. The following Pharmacy Documents are required:

• Completed Pharmacy Agreement Form (Click  HERE  ) - one for each Pharmacy
• Pharmacy Policies and Procedure as required by O.C.G.A § 26-4-116. Must be approved and signed by the Medical Director
• Formulary as approved by the Medical Director - Must be approved and signed by the Medical Director.

Each EMS Agency that is not using a complete Service Delivery Contract must have a Data Management Policy that addresses the following:

• How the EMS agency will address the following measure types based on their data:
  • Timeliness
  • Accuracy
  • Completeness
  • Uniformity
  • Integration
  • Accessibility
  • Validity
• The Data management policy requirements listed in the EMS Data Compliance and Reporting Policy under Section 5.8 must be ALL addressed within the policy submitted by each EMS Agency. 

The new EMS Data Compliance and Reporting Policy will be in effect as of May 8, 2023. Click Here to review. 

Please click here to review more information on EMS data submission requirements. 

Each EMS Agency that is not using a complete Service Delivery Contract must have protocols for each of the following:

• Infectious Disease Exposure Control Plan
• Cardiac Protocols:
  • STEMI Treatment and Transport
  • Cardiogenic Shock Treatment and Transport
  • OHCA Treatment and Transport
• Stroke Protocols:
  • Stroke Treatment and Transport
  • Stroke Triage Tool (CPSS is the State recommended one)
  • Stroke Severity Tool (FAST-ED is the State recommended one)
• Trauma Protocols:
  • General Trauma Treatment and Transport - must reference the CDC Field Triage Criteria
  • Other protocols for the assessment, management and transport of patients with specific traumatic injuries
• Other protocols that address each of the clinical guidelines that are listed in the current version of the NASEMSO Model EMS Clinical Guidelines (Click HERE for the January 2019 Version)

Each EMS Agency that is not using a complete Service Delivery Contract must also submit the following:

• Insurance Information including letter from ACCG (if Government) or ACORD 25 and if needed ACORD-101/129)
• Locations list
• Vehicles list
• Personnel list
• Dispatch Log Template - this is from your CAD system or your written dispatch log and must contain all of the elements listed in DPH Rules and Regs.
• Data Management Policy - this is a policy that addresses your ePCR software vendor and how your medics complete the ePCRs and your Data Manager checks the data.
• CLIA Certificate of Waiver (see this webpage)

• 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

• All EMS Agencies must 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.
• EMS Agency Authorized Agents should carefully follow the directions emailed to them @ 120, 90, 60, 30, 10, 5, & 1 days prior to the EMS Agency License Expiration Date

All revisions to EMS Agencies must be submitted on the Georgia EMS License Management System (LMS). 

Here is a list of the revisions that you can do using LMS:

AA = Authorized Agent
EA = EMS Agency Admin
MD = Medical Director