Get La Ems Aed Form - New Dhh Louisiana 2020-2025

This guide aims to provide clear and comprehensive instructions on how to complete the LA EMS AED Form - New Dhh Louisiana online. By following these steps, users can ensure compliance with regulations regarding automated external defibrillator acquisition.

Follow the steps to fill out the LA EMS AED Form online:

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the entity or person's name in the designated field. This is the name of the organization or individual acquiring the AED.
3. Provide the point of contact's name in the appropriate section. This should be the person who will be responsible for communication regarding the AED.
4. Fill in the address where the AED will be located or where the entity is registered.
5. Input the phone number of the entity or point of contact to facilitate communication.
6. If applicable, add the fax number. This information is optional unless specifically requested.
7. Enter the email address of the point of contact for digital communication regarding the AED.
8. Specify the AED acquisition date in the given field to indicate when the AED was obtained.
9. Provide the serial number of the AED, which can usually be found on the device itself.
10. Select the make and model of the AED from the corresponding fields to ensure proper identification.
11. Indicate the exact location where the AED will be stored or used.
12. Fill in the name of the licensed physician or advanced practice registered nurse who will oversee the AED program.
13. Input the license number of the supervising physician or nurse to verify their credentials.
14. Provide the address for the supervising physician or advanced practice registered nurse.
15. Enter the phone number of the supervising physician or advanced practice registered nurse.
16. If applicable, include the fax number of the supervisory professional.
17. Input the email address of the supervising physician or advanced practice registered nurse.
18. Review all the entered information for accuracy to ensure compliance with the requirements.
19. Sign the form using the electronic signature field by typing your name.
20. Include your title and the date to complete the form.
21. Finally, save the changes made to the document. You can also download, print, or share the form as needed.

Complete your LA EMS AED Form online to ensure timely compliance and proper documentation.