Get In State Form 46604 2014-2025

Filling out the IN State Form 46604 online is a straightforward process that ensures your application for supervising hospital certification is completed accurately. This guide provides step-by-step instructions to help users navigate each section of the form with ease.

Follow the steps to fill out the IN State Form 46604 online:

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Identify the type of certification you are applying for by selecting 'New,' 'Renewal,' or 'Upgrade/Additional'.
3. Fill in the level of hospital by marking either 'Advanced,' 'EMT-Intermediate,' or 'Paramedic' as applicable.
4. Provide the common operating name of your organization along with the legal name as filed with the Indiana Secretary of State.
5. Enter the county of your organization, along with the complete address, including number and street, city, state, and ZIP code.
6. Input the organization’s telephone number and, if different, the mailing address.
7. List the fax number of the organization and provide details for the Chief Executive Officer, Chief of Medical Staff, and EMS Coordinator, including their names, titles, and daytime telephone numbers.
8. Ensure that the Chief of Medical Staff and EMS Coordinator sign and date the form.
9. In the narrative instructions, describe your communication system as per FCC rules and any other necessary communication arrangements.
10. Attach any required documents such as the current FCC license, written approvals, and agreements as instructed in the form.
11. Review all provided information to ensure accuracy and completeness.
12. Once satisfied with the information, users can save changes, download, print, or share the form as needed.

Complete the IN State Form 46604 online today to ensure your organization meets the certification requirements!