Get Miemss Affiliation

Filling out the Miemss Affiliation form online is a crucial step for users who are either adding, changing, or verifying their affiliations with EMS services in Maryland. This guide provides clear, step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to complete the Miemss Affiliation form online:

1. Press the ‘Get Form’ button to access the Miemss Affiliation form and open it in your preferred editor.
2. Select the appropriate checkbox to indicate whether you are adding a new initial affiliation, changing your initial affiliation, or adding an additional affiliation.
3. Indicate the specific type of affiliation by checking the box for ALS, BLS, or EMD.
4. Enter your name in the designated field and provide your Social Security Number.
5. Provide the new affiliation identification number, which should be copied from Application 1 or refer to Appendix B of the User’s Manual.
6. Fill in the affiliation number and name in the specified fields.
7. In the company verification section, have the senior EMS officer complete the verification by signing and providing their title, printed name, and day telephone number.
8. For EMS operational program signature, ensure that the representative of the appropriate agency signs, includes their title, and fills in the date and printed name.
9. If applicable, the Medical Director should sign in their section, confirming that the candidate meets all local and state requirements.
10. Finally, the applicant must sign the form confirming that all information is accurate and provide the date.
11. Review all entries for completeness and accuracy before saving your changes, downloading, printing, or sharing the completed form.

Complete your Miemss Affiliation form online today to ensure your EMS affiliation is up to date.