EMS Licensing Unit MC 1876 P.O. Box 149347 Austin, Texas 787149347 Main: (512) 8346734 Fax (512) 2063779 Email: EMSCert dshs.texas.govTo request a replacement EMS wallet card, submit completed form.
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How to fill out the TX HHS EMS Certificate/Wallet Card Replacement Form online
This guide provides step-by-step instructions for filling out the TX HHS EMS Certificate/Wallet Card Replacement Form online. By following these instructions, users can easily navigate the online form and ensure that their application is completed accurately.
Follow the steps to complete the EMS certificate or wallet card replacement form online.
- Click ‘Get Form’ button to obtain the form and open it in the online editor.
- In Section 1 - Personnel Data, enter your first name, middle name, and last name in the respective fields. Provide your EMS ID number. Select your position from the list (e.g., EMT, EMS Instructor, etc.) and indicate whether you are enclosing a fee of $10 or if you are exempt from the fee.
- Fill in your address, city, county, state, zip code, telephone number, and email address in the provided fields to ensure accurate contact information.
- If you are requesting a fee exemption, proceed to Section 2 - Volunteer Sign-Off. This section must be completed by an approved EMS Provider or First Responder Organization administrator. Ensure that they include their printed name, signature, organization name, city, DSHS license or registration number, and phone number.
- Proceed to Section 3 – Signature and Date. Read the certification statement carefully. If you agree with the stated terms, sign and date the form in the designated fields.
- Once you have completed the form, review all entries for accuracy. After verifying that all information is correct, you can save changes, download, print, or share the completed form as needed.
Complete your TX HHS EMS Certificate/Wallet Card Replacement Form online today!
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