Get Nys Doh 5065

The Nys Doh 5065 form is essential for the recertification of emergency medical technicians in New York State. This guide will provide a detailed, step-by-step approach to filling out the form correctly online, ensuring that all required information is submitted accurately.

Follow the steps to successfully complete your Nys Doh 5065 form online.

1. Click 'Get Form' button to obtain the form and open it in the online editor.
2. Begin by entering your EMT number and Social Security number in the designated fields. Ensure accuracy to avoid delays in processing.
3. Complete the personal information section: provide your last name, middle initial, and first name in upper case letters.
4. Fill in your address, city, state, and zip code accurately to ensure that correspondence regarding your recertification reaches you.
5. Enter the Agency Code of your participating agency in the specified field.
6. Read the affirmation statement regarding convictions and check the corresponding box. If applicable, be prepared to provide additional information if you have a conviction.
7. Sign and date the application where indicated to confirm the authenticity of the information provided.
8. Document your completed EMT refresher training by entering the total hours earned in the provided section, ensuring they add up to a minimum of 26 hours.
9. Include the CPR certification and attach a copy of your current card (front and back) as required.
10. List any additional hours of continuing education you have completed, along with dates and topics.
11. Complete the skill competency verification section by filling in the required skills and obtaining signatures from the Medical Director or Training Officer.
12. Final declarations: affirm that all provided information is correct by signing and dating in the appropriate sections at the bottom of the form.
13. Once all sections of the form are completed, review your input for accuracy, then proceed to save your changes. You may also download, print, or share the form as necessary.

Complete your Nys Doh 5065 form online to maintain your certification efficiently.