Get Doh 3508 Form Ems

The Doh 3508 Form Ems is essential for individuals seeking recertification as an instructor in emergency medical services. This guide will help you navigate and complete the form accurately through an online platform, ensuring that all required information is provided and properly submitted.

Follow the steps to complete the Doh 3508 Form Ems successfully.

1. Press the ‘Get Form’ button to access the Doh 3508 Form Ems, allowing you to open and edit it online.
2. Fill out Section A: Applicant Information. Provide your certified lab instructor or certified instructor coordinator information, including your EMT/AEMT number, name, address, phone numbers, and email address. Make sure all details are accurate.
3. Complete Section B: CLI/CIC Teaching Experience. Indicate your role as a laboratory instructor or certified instructor coordinator, along with the course numbers and your course sponsor code.
4. In Section C, provide information about the NYS DOH Bureau of Certified EMS Instructor Update course you have completed. This includes the location, course number, and the date of completion.
5. Fill in Section D: Pre-hospital Patient Care Experience. Record the name of the EMS agency you have been affiliated with, the agency code, and the dates during which you provided direct, hands-on patient care.
6. In Section E: Personal Affirmation, affirm that you have not been convicted of any misdemeanors or felonies. Sign and date the application, ensuring you certify the accuracy of your information.
7. After reviewing all sections for completeness and accuracy, save your changes. You can then download, print, or share the completed form as needed.

Complete your Doh 3508 Form Ems online today to ensure your recertification process is seamless.