Office of Emergency Medical Services

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Applications/Forms

Contained on this page are various forms and applications required for licensure of providers and vehicles. If you do not find a form you require, please call 609-633-7777.

  • Background Check for Agency Licensure [pdf 369k]

  • Instructions for EMS Licensing Application [pdf 978k]

  • Application for New Providers
  • Basic Provider Forms

  • Pediatric Assessment Chart [pdf 1m]

  • PEDIATRIC - Sudden Unexplained Infant Death Form A

  • PA/NJ EMT Continuing Education Form

  • Sample Inspection Forms

  • Quarterly Report Forms

  • Training Fund Forms and Information
    Copies of the Eligibility Form and Scannable Sign-In Sheet must be attached to the Reimbursement Form when submitting for payment.

  • Request Materials (On-Line Forms)
    • Ambulance Pediatric Posters Request Form
    • NJ Disaster Triage Tag Request Form

 

  

Emergency Medical Services Payments

Submit Payments