Get Louisiana Emt Reinstatement Form

The Louisiana Emt Reinstatement Form is essential for individuals seeking to reinstate their expired emergency medical technician certification. This guide provides comprehensive instructions on how to complete the form online, ensuring a smooth and efficient application process.

Follow the steps to complete your application successfully.

1. Press the ‘Get Form’ button to access the Louisiana Emt Reinstatement Form in your online editor.
2. Carefully print or type your information legibly throughout the form. Start by entering the required personal data including your last name, first name, middle initial, and social security number.
3. Provide your mailing address, including city, state, zip code, and contact information such as home and cell phone numbers, as well as your email address.
4. Specify your certification level and registry number, and indicate the correct re-instatement fee per your certification type (e.g., EMT-Basic for $25.00).
5. If applying as an EMT-Basic, respond to questions 3B and 3C regarding your employment status, ensuring you follow any specific instructions related to reimbursement eligibility.
6. Complete the EMS certification commission disclosure section by answering each question accurately regarding your EMS practice, criminal history, any disciplinary actions, or medical conditions.
7. Fill in the employer information section, detailing your employer type and confirming whether you perform EMS duties outside governmental responsibilities.
8. Affirm the truthfulness of all statements made in the application by providing your original signature and the date.
9. Prepare a money order made out to 'Bureau of EMS' for the required fee, and include any necessary supporting documentation, such as your National Registry card.
10. Finally, submit your completed application either by mailing it to the Bureau of EMS at the specified address or delivering it in person. For verification, consider sending it via certified mail.

Start your application process online today and ensure your reinstatement is handled efficiently.