Get Mi Bhs/ems-180 2016-2025

The MI BHS/EMS-180 is a critical form used for licensing life support agencies in Michigan. This guide will provide step-by-step instructions to help users accurately complete the online version of this form, ensuring all necessary information is correctly submitted.

Follow the steps to complete the MI BHS/EMS-180 effectively.

1. Press the ‘Get Form’ button to access the form and open it in your document editor.
2. Begin by indicating the reason for submitting the application by checking one of the boxes: ‘New’, ‘Renewal’, or ‘Change of information’. If you select ‘Change of information’, please indicate the specific changes.
3. Select the level of agency you are representing by checking one box from the options: ‘First Responder’, ‘Basic’, ‘Limited Advanced’, or ‘Advanced’.
4. Fill in the company name and the geographic service area for emergency calls only.
5. Input the street address, city, state, zip code, and the name and contact information of a designated contact person.
6. Provide the federal identification number and phone details for your agency.
7. Select the type of staff associated with your agency by checking either ‘Paid’, ‘Volunteer’, or ‘Other’. If ‘Other’ is selected, please specify.
8. Indicate the type of service provided by checking one of the available options, such as ‘Ambulance Operation’ or ‘Medical First Response Service’.
9. If applicable, check any additional services offered by your agency, such as ‘Fire’ or ‘Police Dept.’.
10. If your agency operates under a different name, list those names as required.
11. Complete the section for the legally responsible person, including their printed name and signature. Ensure to sign the attestation regarding the agency's operations.
12. Confirm that the expiration date is filled in, if applicable, before submitting.
13. Once all sections are completed, review the form for accuracy. You may then save your changes, download, print, or share the completed form as necessary.

Complete your MI BHS/EMS-180 form online today to ensure your agency remains licensed.