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Forms

EMS Personnel Forms

Initial Application Forms Renewal Forms
State License Application and Instructions EMS Personnel Renewal
EMR - Emergency Medical Responder Application and Instructions EMR - Emergency Medical Responder Renewal
EMS Instructor Application EMS Instructor Renewal

Practical / Psychomotor Exams

Psychomotor Skill Exam - Registration Process (Career-Tech)

ALS Practical Test/Retest OSDHApplication Form

Duplicate License Application
  Affidavit of Lawful Presence


Agency License / Registration

EMS - Ground Ambulance Service Application
EMS - Air Ambulance Service Application
EMS - Stretcher Aid Van Service Application
EMS - Specialty Care Service Application
EMRAgency Application (Emergency Medical Responder)


Inspection Forms

Ground Ambulance Vehicle Inspection EMS - Records Review
Air Ambulance Vehicle Inspection EMRAgency  - Records Review
Stretcher Aid Van Vehicle Inspection SAV - Records Review
Specialty Care Vehicle Inspection uses the same form as Ground Ambulance Specialty Care uses the same form as EMS however they must supply a list of the equipment they are using in the specialty care capacity

 

Education / Training

CAN - Course Authorization 2011 EMT National Registry Practical
Course Modification Form 2012 EMR National Registry Practical
Course Roster (Initial - Final - Amended) ALS Practical Test/Retest Application Form
State EMR Training and Testing Verification Practical Site Summary
Verification of Training to test at an Alternate Site  
Transition Courses: Transition Course OUTLINES:
     First Responder to Emergency Medical Responder       FR to EMR Course Outline - 7-2012
     Basic to EMT      EMTB to EMT Course Outline - 7-2012
     I-85 to AEMT  
     EMT-P to Paramedic  
  CURRICULUM:
FAQ's Go to Education tab on EMS Main page for breakdown


All Other Forms:

Annual Survey (sample)
Change of Medical Director Checklist
Course Initial Roster (sample)
Course Final Roster (sample)
Course Practical Skills Exam Roster (sample)
Crew Roster (sample)
Crew Schedule (sample)
Death Benefit Beneficiary Form
Exposure Control Plan - Communicable Disease (sample)
Extrication Agreement (see Mutual Aid Agreement)
Individual Protocols - Application
Individual Protocols - List of Crew
Individual Protocols - Quality Control Checklist
KKK Ambulance Specifications
Medical Director Agreement - (sample)
Mutual Aid Agreement (sample)
Oklahoma Tax Commission Compliance
Patient Care Report (sample)
Quality Assurance Guideline (sample)
Quality Assurance Procedure (sample)
Referral Form - QI Intake Form
RTAB - Authorized Rep Form
Rules and Statutes Book 2009
Run Log - (sample)
Run Report - EMS Patient Care Report (sample)
Run Report - EMR (sample)
Special Event Memo From OSDH EMS Director
T3 Algorithm
TReC - Trauma Referral Center Flier

 

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