Ambulance Service Licensure

Initial License Requirements

The Georgia Department of Public Health Rules and Regulations Chapter 511-9-2 to license, re-license, and monitor Ambulance Services, Air Ambulance Services, Medical First Responders, and Neonatal Transport Services.

An applicant for ambulance service licensure must submit to the Office of EMS and Trauma a complete application packet along with all other required documents and fees. Forms and additional documents can be found below. Each ambulance to be operated under the license must be inspected and approved by the department and so registered by affixing a department decal at a location specified by the department.

New EMS Agency License Requests

All New EMS Agency License Requests must follow these steps, as paper applications will no longer be accepted:

Step 1: Email Diane Strickland (linda.strickland@dph.ga.gov) 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 "noreply@imagetrend.com" that they have been added as an Authorized Agent. Once you get that email, you will then need to gather these documents that will be required for the online EMS Agency application:

For ALL EMS Agencies:

  • A completed and notarized Authorized Agent Designation form (Click Download this pdf file.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

For EMS Agencies who will use a Service Delivery Contract to meet the license requirements:

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

For EMS Agencies who do not have a 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)
  • Completed Medical Director Agreement Form (Click Download this pdf file.HERE )
  • Pharmacy:
    • Completed Pharmacy Agreement Form (Click Download this pdf file.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.
  • Data:
    • Dispatch Log Template (Click HERE for a sample)
    • Data Management Policy - must include how the medics enter data themselves into an ePCR system, who verifies that the data is sent to GEMSIS Elite, and how data validation occurs
  • Protocols:
    • 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)
  • Insurance Information including letter from ACCG (if Government) or ACORD 25 and if needed ACORD-101/129)
  • Locations list
  • Vehicles list
  • Personnel list

Forms for License Management System (LMS): 

Download this pdf file.Authorized Agent Certification
Download this pdf file.EMS Agency Admin Certification
Download this pdf file.Medical Director Agreement Form
Download this pdf file.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

Renewal License Requirements: All ambulance service licenses must be renewed every two years. Renewal notices are mailed by the Regional Director and must be returned by the deadline with appropriate fees and application. See below for renewal applications for Corporations, LLCs, Governments, Authorities, and Sole Proprietors.

Current Ambulance Service Renewal Application

Current EMS Agency Revisions

  • All revisions to EMS agency licenses must be made in the License Management System (www.mygemsis.org/lms)

Yearly License Anniversary Dues

All ambulance services holding an active license must pay their anniversary dues every year with a check along with a copy of current insurance. No application is required when submitting anniversary dues.

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

 

Page last updated 2/10/2020