Commercial Ambulance Applications & Forms

 TitleDescription
Add Vehicle ApplicationApplication to add a vehicle.
Commercial Ambulance Equipment ListCommercial Ambulance Equipment List 2009
Fee ScheduleFiscal year 2008 price list for Commercial Ambulance Licensing & Regulation.
Medical Director AgreementThe medical director agreement.
Personal Injury Report FormThe Personal Injury Report Form.
Personnel ListThe personnel list.
Required Neonatal Equipment List The required neonatal equipment checklist.
Required Specialty Care Equipment ListThe required specialty care equipment checklist.
Service ApplicationCommercial Ambulance Services Licensing Application.
Transfer Vehicle License ApplicationThe application to transfer vehicle license.
Upgrade/Downgrade Vehicle ApplicationApplication to upgrade/downgrade vehicle license.
Vehicle Collision & Personal Injury Report FormThe Vehicle Collision & Personal Injury Report Form.

EMS Provider Forms

 TitleDescription
Affiliation & Student Application Release FormMaryland Emergency Services Student Application Release and Affiliation Form.
ALS Class Application Advanced Life Support Application Timelines and the ALS Program Course Approval Application.
Change of InformationThis form is to be used for pre-hospital providers who wish to document a change in name, address, or social security number.
Course Request FormThis form is to be used by instructors and/or sponsoring agencies when requesting a BLS course. Must be received at least 20 days prior to class start date.
CRT-99 with National Registry Relicensing ApplicationCardiac Rescue Technician License Renewal Application. For use ONLY by CRT's having National Registry EMT-Intermediate/99 Certification.
CRT-99 WITHOUT National Registry Relicensing ApplicationCardiac Rescue Technician License Renewal Application. For use ONLY by CRT's NOT having National Registry EMT-Intermediate/99 Certification and originally licensed before July 1, 2001.
EMT-P Relicensing ApplicationEMT-Paramedic License Renewal Application. This application MUST be received by MIEMSS at least 14 days prior to expiration of your current EMT-P license.
Extension RequestForm for requesting an extension of pre-hospital provider's license or certification. Must be received prior to current license/certification expiration date.
Maryland EMS Continuing Education Course ApplicationThis form is to be used by instructors and/or sponsoring agencies when requesting a Continuing Education number. Must be received at least 14 days prior to class start date.
Surrender FormThis form is to be utilized by Maryland pre-hospital providers when requesting to surrender their current license/certification.