Sacramento County - EMS APPLICATION FORMS

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EMS APPLICATION FORMS

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EMT-I CERTIFICATION/RECERTIFICATION*

	EMT-I Application Form
	Health and Safety Affidavit
	EMT-I Certification/Recertification Information
	DOJ Request for Live Scan Service Form 8016
	DOJ and FBI Request for Live Scan Service Form 8016
	EMT-I Background Check Guidelines
	EMT-I Skills Competency Verification Form
	EMT-I Skills Form Instructions
	NREMT CBT Exam Information *NOTE: To apply for EMT-I Certification or Recertification, both the Application Form and the Health & Safety Affidavit must be submitted.

MICN CERTIFICATION/RECERTIFICATION

MICN Application Form

PARAMEDIC ACCREDITATION/RE-ACCREDITATION/CONTINUOUS

Paramedic Application Form

AUTOMATIC EXTERNAL DEFIBRILLATOR (AED) FORMS

	EMT-I/Public Safety AED Designation Agreement
	EMT-I Quarterly Stats Reporting Sheet
	Public Safety Quarterly Stats Reporting Sheet
	Non-Licensed/Non-Certified Personnel Automated External Defibrillator (AED) Provider Utilization Report Form
	Non-Licensed/Non-Certified AED Provider Registration

MULTI-CASUALTY INCIDENT (MCI) CRITIQUES

	Out-of-Hospital Providers MCI Critique
	Receiving Facility MCI Critique
	Control Facility MCI Critique

MOBILE INTENSIVE CARE NURSE (MICN) RIDE-ALONG FORM

Ride-Along Form

EMT-I TRAINING PROGRAM APPROVAL FORMS

	Training Program Checklist
	Training Program Approval Summary Sheet
	Training Program Approval Program Director
	Training Program Clinical Coordinator
	Training Program Principal Instructor
	Training Program Teaching Assistant
	Training Program Hospital Clinical Coordinator
	Training Program Class Site Location
	Training Program Hospital/Ambulance Affiliation

CONTINUING EDUCATION (CE) PROVIDER APPROVAL FORMS

	CE Provider Approval Checklist A
	CE Provider Approval Checklist B
	CE Provider Approval Program Director
	CE Provider Approval Program Clinical Director
	CE Provider Approval Program Instructor
	CE Provider Approval Teaching Assistant
	CE Provider Approval Course Summary

DO-NOT-RESUSCITATE (DNR) AUTHORIZATION FORMS

	Physician Orders for Life-Sustaining Treatment (POLST) Form
	Order forms at: California Medical Association Forms Website

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