Get Emrangancy Form

Completing the Emrangancy Form online is an essential step for emergency medical response agencies seeking certification. This guide will walk you through each section of the form, ensuring that you provide the necessary information accurately and completely.

Follow the steps to fill out the Emrangancy Form online

1. Click 'Get Form' button to access the Emrangancy Form and open it in your preferred editing tool.
2. Fill out the administrative information section. Provide the name of your organization, date of application, mailing address (including city, state, and zip code), physical address (if different), and the contact person along with their telephone numbers.
3. In the ambulance services section, list all of the licensed ambulance services that will provide transportation services. If necessary, use an additional sheet for any extra services.
4. For the support level, indicate the level of care your agency will provide by checking the appropriate box: Emergency Medical Responder, Basic, Intermediate, or Paramedic.
5. Complete the medical control section by entering the name and license details of your medical director, including their Oklahoma State license number and OBNDD number. Attach the required documentation, including a resume or CV.
6. Provide additional required information. This includes a medical director’s letter of consent, endorsement from the appropriate governmental authority, a personnel roster, equipment list, insurance copies, and a map of your service area.
7. In the verification statement, ensure an authorized representative from your agency signs and dates the application to confirm the accuracy of the information provided.
8. Finally, review your completed form for any missing sections or signatures. Save your changes, and you may choose to download, print, or share the completed Emrangancy Form as needed.

Begin filling out your Emrangancy Form online today to ensure your agency is prepared for certification.