EMS Forms and Resource Documents

Forms for Ambulance Services - Corporations and LLCs ONLY

Forms for License Manager System (LMS):

Authorized Agent Certification
Medical Director Agreement Form
Pharmacy Agreement Form

Vehicle Inspection Forms

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

Current Ambulance Service Renewal Application

EMS Service License Renewal Application Packet

Current Ambulance Service Revision Forms

Use the following revision forms to add or delete base and satellite locations, vehicles and EMS personnel.  

Add/Delete Base and Satellite Locations
Add/Delete Ambulance Vehicles
Add/Delete Licensed EMS Personnel
Update Insurance - Submit Acord Form 25 and Acord Form 101 (must list all insured vehicles).

For other revisions please use the EMS Service License Application Packet be sure to mark "Revision" on the application. 

Forms for Ambulance Services - Governments, Authorities, and Sole Proprietors ONLY

Vehicle Inspection Forms

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

Current Ambulance Service Renewal Application

EMS Service License Renewal Application Packet (GA EMS 1000)

Current Ambulance Service Revision Forms

Use the following revision forms to update insurance, add or delete locations, vehicles and EMS personnel. 

Update Insurance Information - Schedule A
Add/Delete Base Locations
Add/Delete Licensed EMS Personnel - Schedule E
Add/Delete Ambulance Vehicles - Schedule F

For other revisions please complete them on the EMS Service License Application Packet (GA EMS 1000) be sure to mark "Revision" on the application.

Specialty Designation Information


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


Page last updated 10/10/19