Get Patient Contact Form For Emt-ii Candidates - Alaska Department Of ... - Dhss Alaska

This guide provides step-by-step instructions on how to complete the Patient Contact Form for EMT-II candidates, ensuring that applicants meet the necessary requirements for training. By following these directions, users will accurately provide the required information in a clear and organized manner.

Follow the steps to complete your Patient Contact Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section A, provide your personal details as the applicant. Fill in your full name and ensure that your Alaska EMT-I Certification Number is accurate. Additionally, enter the printed name and signature of your EMT-II course instructor, along with the start date of your course, and the date you are completing the form.
3. Move to Section B, which focuses on witness information. If a witness was present during the patient contact, complete the lines for the witness name and their level of training. If the EMS Chief or Training Officer is verifying the patient contact, include their information instead.
4. Next, enter the witness's contact phone number or email address in the appropriate field, which is necessary for verification purposes.
5. Have the witness confirm their presence by signing their name in the designated area. If there was no witness, ensure that the EMS Chief or Agency Training Officer completes this section.
6. After all sections are completed, make sure to save your changes. You may choose to download, print, or share the form as needed. Remember that the original completed form must be returned to the Section of Community Health and EMS with your application, and a copy must be presented to your EMT-II instructor prior to class enrollment.

Complete your Patient Contact Form online today to ensure your eligibility for EMT-II training.