Get Md Miemss Request For Extension Of Certification Or License 2008-2025

Filling out the MD MIEMSS Request For Extension Of Certification Or License is an essential step for individuals seeking to maintain their certification or license in emergency medical services. This guide offers clear, step-by-step instructions to help you complete the form online efficiently.

Follow the steps to complete your request for extension.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by filling in your current provider level. Select the appropriate option from the following: First Responder, EMT - B, Emergency Medical Dispatcher, CRT, or EMT-Paramedic.
3. Provide your Social Security Number in the format _______ – ____ – _________. This step is important for identification purposes.
4. Enter your full name as follows: last name, first name, middle name, and any suffix (Jr./Sr.).
5. Input your home address, including street, apartment number (if applicable), city, state, and zip code.
6. Fill in your phone numbers, including home and work, as well as your email address for communication regarding your application.
7. State your reason for requesting an extension clearly in the designated section.
8. Answer the questions regarding previous healthcare certifications or licenses and any criminal convictions. Depending on your answers, you may need to provide additional documentation.
9. Sign the application, including the date of submission.
10. Once completed, save your changes. You can then download, print, or share the completed form as necessary.

Complete your MD MIEMSS Request For Extension Of Certification Or License online today for seamless processing.