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:

The Data Management Policy MUST address the following:

• Must include which ePCR software (state-provided or 3rd party vendor) the agency is using for data submission.
• Must include Data Manager contact (This person MUST be in LMS as the Data Manager, with a phone number and email address)
• Medics must be the ones to complete the ePCRs
• Medics must complete ePCR before the end of the current shift
• Medics must comply with all validation rules (before the end of the shift)
• ePCR data must be submitted to GEMSIS Elite within 24 hours of call completion (based on eTimes.13)
• Calls must be submitted via NEMSIS V3.4 web services to GEMSIS Elite (only for 3rd party vendors)
• Agency Data Manager for NEW agencies must check data submissions daily for 2 weeks, and then weekly after that.
• Agency Data Manager for existing agencies must check data submissions weekly
• Agency Data Manager is checking data for:
  • Validity score (calls less than a score of 95 must be corrected and resubmitted to GEMSIS Elite)
  • The thoroughness of narratives (select a random sampling for this)
  • Call volume in GEMSIS Elite matches call volume in the agency's dispatch log
  • Failed Imports (failed imports must be corrected and re-submitted to GEMSIS Elite)
• Policy must be signed and dated by the Authorized Agent 

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

• 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

• 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.
• 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 ambulance services holding an active license must pay their anniversary dues every year with a check.
• 90 days prior to the Anniversary date for an Ambulance Service (Air, Ground, Neonatal), LMS will email the EMS Agency to go in and make sure that their vehicles are accurate - you will have 10 days to make sure this is correct
• The Regional Director will set charges for the anniversary 80 days prior to the Anniversary date, and LMS will email the invoice to the EMS Agency. The EMS Agency must then send in their payment along with a copy of the invoice to:
  • Georgia Office of EMS and Trauma,
  • ATTN: EMS Agency Anniversary Payments
  • 1680 Phoenix Blvd, Ste 200, Atlanta, GA 30349

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