Get New York State Department Of Health Bureau Of Ems Policy Statement 09-02 Re. Extension Of

This guide provides clear instructions on how to fill out the New York State Department of Health Bureau of EMS Policy Statement 09-02 concerning certification extensions for military personnel. This policy statement offers vital information to ensure that individuals transitioning from active military duty can extend their emergency medical certification effectively.

Follow the steps to complete the certification extension form.

1. Click ‘Get Form’ button to access the Certification Extension for Military Personnel form. This will allow you to open the necessary document for completion.
2. In the form, fill out your personal information. Ensure you provide your first name, middle initial, last name, address, city, state, zip code, county, and sex. All fields must be completed in UPPER CASE letters to maintain clarity.
3. Enter your Social Security number and date of birth in the specified fields. This information is required to verify your identity.
4. Indicate your participating agency, including the DOH agency code, and your CFR/EMT/AEMT number by checking the appropriate certification level that applies to you.
5. Provide the expiration date of your current CFR/EMT/AEMT certification. Ensure that this date is recorded accurately to avoid any issues with your application.
6. Complete your home phone number, including the area code. This allows the Bureau of EMS to contact you if necessary.
7. Check the appropriate box to indicate your branch of military service. This is important for processing your request for certification extension.
8. If applicable, check the boxes for CIC or CLI if your Instructor certification expired during your active duty.
9. Review the completed form to ensure all information is accurate and complete. Incomplete forms may be denied and returned.
10. Return the completed form together with a photocopy of your official military separation documentation (i.e. DD-214 or DA Form 2-A Statement of Release from Active Duty) to the address listed on the form.
11. Upon submission, wait for a response. Within two weeks after receiving your documentation, the Bureau of EMS will review it and, if approved, issue a new certification card with an extended expiration date.

Complete your certification extension application online to ensure continuity in your emergency medical service credentials.