Get Application 2010 0004a Emr Application - Department Of Health

Completing the Application 2010 0004A EMR Application online is a crucial step for individuals seeking certification as Emergency Medical Responders in the District of Columbia. This guide provides a clear roadmap to help users accurately fill out the application, ensuring that all required information is included for a smooth processing experience.

Follow the steps to successfully complete your EMR application online.

1. Click ‘Get Form’ button to obtain the form and open it in your browser.
2. Select your application type by marking the appropriate option: Initial Certification, Renewal of Certification, Reciprocity, or Reinstatement.
3. Complete the personal information section, including your last name, first name, any other names used, gender, Social Security Number, birth date, address, and contact information.
4. In the Required Certifications section, provide details about your NREMT certification such as expiration date, training agency, level, and number.
5. List your work experience as an EMS provider for the past ten years, indicating dates for each position held.
6. In the Professional History section, answer questions regarding any health professional licenses or certifications you hold or have held. Provide additional details if applicable.
7. Confirm if you owe any fines or penalties to the District of Columbia, and provide necessary documentation if your answer is 'Yes'.
8. Sign and date the certification statement at the bottom of the application to confirm the truthfulness of the information provided.
9. Obtain the signature of your sponsoring EMS agency's Medical Director, confirming your membership and competence.
10. Review your completed application to ensure all information is accurate. Save your changes and then print a copy for your records.
11. Submit the application along with all required documentation and the appropriate fee to the Department of Health.

Complete your EMR application online today to ensure timely processing of your certification.