Get 18220 Fill-in Form Fillable Pdf Template Download Here!

The 18220 Fill-in Form Fillable Pdf Template is essential for certified paramedics to report their continuing education and maintain their certification. This guide provides step-by-step instructions on how to fill out this form accurately and effectively.

Follow the steps to successfully complete the 18220 Fill-in Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your registrant information in the designated fields. Fill in your public safety identification number, Indiana certification number, driver’s license number, and home telephone number.
3. Next, provide your printed name (last, first, middle initial) and email address.
4. Enter your home address, including the street number, city, state, and ZIP code.
5. Indicate if you have been trained in NIMS/ICS by selecting 'Yes' or 'No' and specify your level of training if applicable.
6. Respond to the question about willingness to assist in a disaster by selecting 'Yes' or 'No'.
7. Fill out the Violation Statement section, indicating whether you have been charged or convicted of a crime other than minor traffic violations. If 'Yes', attach the required documentation.
8. Sign and date the Signature of EMS Medical Director section, ensuring to include the physician's printed name, license number, state, and telephone number.
9. Proceed to the Signature of EMS Registrant section, where you will affirm that all statements provided are true. Include the date and your signature.
10. Complete the Current Affiliations sections for both Ambulance Provider Organizations and Supervising Hospital, including necessary signatures and dates.
11. In Section IA, detail your EMT-Paramedic refresher training by listing the date, number of hours, and topics covered. Ensure each entry includes the instructor's signature.
12. Attach current CPR and ACLS certifications as required in Sections IB and IC.
13. In Section II, report an additional twenty-four hours of continuing education, specifying the date, number of hours, topic, and instructor's signature.
14. Finally, in Section III, document the verification of skill competence by listing the skills, dates, and obtaining original signatures for each.
15. After completing all sections, you can save changes, download, print, or share the form as needed.

Complete your documents online to ensure your certification stays current!