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Oklahoma EMS Training Program RenewalForms

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
Duplicate License Application License/Certification Extension Request
Military Waiver Initial Application Affidavit of Lawful Presence
Conditional License Application  

Psychomotor Skill Exam - Registration Process (Career-Tech)

ALS Practical Test/Retest OSDHApplication Form


Agency License / Registration

EMS - Ground Ambulance Service Application
EMS - Air Ambulance Service Application
EMS - Stretcher Aid Van Service Application
EMS - Specialty Care Service Application
Pre-hospital EMRA 
Pre-hospital EMRA's will operate as part of an Emergency Medical System, responding to requests for service within a response area,supporting and being supported by a licensed ambulance service.
Event Stand-by EMRA 
Event Stand-by EMRA's will operate or contract for on-site medical care at locations that are open to the public or that will respond to the public.These types of EMRA's are certified to standby at a location or site and provide medical care to the public.

Agency Renewal Forms

EMS Agency Renewal form - for Ground, Air, Stretcher Aid and Specialty Care agencies
EMRA Renewal form - for Prehospital and Standby EMRA's.

Agency Amendment Forms

EMS Agency Amendment form - for Ground, Air, Stretcher Aid and Specialty Care agencies
EMRA Amendment form - for Prehospital and Standby EMRA's.

Oklahoma EMS Training Program Application

Oklahoma EMS Training Program Renewal


Inspection Requirements

EMRA Equipment/Record Review
EMS Ground Agency Records Review
EMS Ground Ambulance Inspection Form
EMS Air Agency Records Review
EMS Air Ambulance Inspection Form
Specialty Care Agency Records Review
Specialty Care Ground Ambulance Inspection Form
Specialty Care Air Ambulance Inspection Form
Stretcher Aid Van Ambualnce/Records Review

Education / Training

CAN - Course Authorization 2011 EMT National Registry Practical
Distance Learning Site Data 2012 EMR National Registry Practical
Course Modification Form ALS Practical Test/Retest Application Form
Course Roster (Initial - Final - Amended) Practical Site Summary
State EMR Training and Testing Verification  
Verification of Training to test at an Alternate Site CURRICULUM:
        Go to Education tab on EMS Main page for breakdown

All Other Forms:

Death Benefit Beneficiary Form
Exposure Control Plan - Communicable Disease (sample)
2018 OSDH Protocols Application  - Includes directions for Individual Protocols
Medical Director Checklist
Referral Form - QI Intake Form
RTAB - Authorized Rep Form
Run Report - EMS Patient Care Report (sample)
Run Report - EMR (sample)
T3 Algorithm
TReC - Trauma Referral Center Flier



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