Oklahoma, www.OK.gov <{$map[0].NAME}>

Contact  |  A-Z Health Index  |  Events & Meetings

get adobe reader

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 OSDH Application 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: Curriculum:
     First Responder to Emergency Medical Responder       Go to Education tab on EMS Main page for breakdown
     Basic to EMT  
     I-85 to AEMT FAQ's
     EMT-P to Paramedic  

All Other Forms:

Annual Survey (sample)
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

 

Creating a State of Health Logo