Get Alabama Department Of Public Health Office Of Ems And Trauma - Adph

This guide provides clear and supportive instructions on how to fill out the Alabama Department of Public Health Office of EMS and Trauma application online. By following these steps, users can ensure they complete the application accurately and efficiently.

Follow the steps to fill out the form online:

1. Click the ‘Get Form’ button to access the application and open it in your preferred online editor.
2. Enter the current service ID and county of operation in the designated fields. Provide today's date at the top of the form.
3. Indicate the type of application from the options provided: Transport, BLS, New Service, Non-Transport, ALS, Renewal, Air Medical, or Member AARS.
4. Under 'Contact & Demographic Information', fill in the owner's name, business name (as it will appear on the license), physical address, mailing address, email address, and contact person's details. Ensure all required fields are typed.
5. Input the insurance information, including the insurance carrier and phone number. Attach proof of coverage as required.
6. If you are applying for relicense, include the EMS Management website vehicle roster. If it's a new service, list all active vehicles with their details like unit number, make, type, year, model, and VIN.
7. For personnel, list all active personnel in alphabetical order, providing their EMT license levels, numbers, and employment status (full-time, part-time, volunteer).
8. Sign and date the application, certifying that the information is correct and that EMS coverage will be provided 24/7.
9. Complete any additional agreements required, such as the AIMS Agreement, Off-Line Medical Directors Selection, and Advanced Life Support Agreement.
10. Make a photocopy of the completed application for your records. Submit the original application to the Alabama Department of Public Health Office of EMS and Trauma.

Begin filling out your application online today and ensure all information is submitted accurately.