Get Ma Oems Form 500-1 2015-2025

Completing the MA OEMS Form 500-1 is essential for ambulance service license applications in Massachusetts. This guide provides detailed, step-by-step instructions to help you navigate the online filling process efficiently and accurately.

Follow the steps to successfully complete the MA OEMS Form 500-1 online.

1. Click the ‘Get Form’ button to access the form and open it for editing.
2. Begin by filling out the service number and the service expiration date. Ensure this information is current and accurate.
3. Indicate whether the application is for initial, renewal, or modification. If modifying, specify the type of license you are applying for: Advanced, Paramedic, or Critical Care Transport.
4. Provide service information. Enter the name, address (including P.O. box, if applicable), city, state, business phone number, manager's name, fax number, contact person's name, and e-mail address.
5. Input licensee information. Include the licensee's name, address, contact details, and 24-hour access numbers.
6. List any parent or associated companies of the owner, including their names and addresses.
7. Select the service ownership type, choosing from options like Sole Proprietor, Government, Partnership, Corporation, LLC, Limited Partnership, or Other.
8. Answer whether the service holds other valid licenses in Massachusetts by selecting 'YES' or 'NO.'
9. Choose the level of license applying for: BLS, Advanced, Paramedic, or Critical Care.
10. Indicate the hospital(s) you have an affiliation agreement with, and any associated medications for monitoring.
11. Fill in the total number of vehicles by class and provide staffing levels for different personnel categories.
12. Determine if the ambulance service only responds to calls from a unique population. If yes, specify the population.
13. Report the number of runs performed by the service in the last calendar or fiscal year, including emergency and routine transports.
14. If applicable, indicate whether you currently have any waivers and specify the waiver type.
15. Complete the tax certification statement and provide your social security or federal identification number.
16. Confirm whether there are any outstanding assessments levied by the Commonwealth.
17. Finally, review all the information for accuracy. Ensure the authorized signature is provided along with the date.
18. Once all sections are filled, save your changes. You have the options to download, print, or share the completed form.

Complete the MA OEMS Form 500-1 online today to ensure your ambulance service is properly licensed.