| Release Date |
AEMT Course Record | 5/10/2012 |
AEMT Skills Verification Form | 1/1/2007 |
AEMT Training Program Approval Packet (NEW) | 2/19/2015 |
ALS Provider Agency Changes in Personnel Quarterly Report Form | 1/30/2012 |
Application for Approval as an ICEMA Designated Cardiovascual STEMI Receiving Center (SRC) | 11/1/2014 |
Application for Approval as an ICEMA Designated Neurovascular Stroke Receiving Center (NSRC) | 11/1/2014 |
Automated External Defibrillator (AED) Annual Usage Report Form - Public Safety | 7/1/2015 |
Automated External Defibrillator (AED) Site Notification Form | 7/1/2015 |
Automated External Defibrillator (AED) Use Notification Form | 7/1/2015 |
California Department of Public Health (CDPH) Hospital Emergency Program Flexibility Form for Temporary Permission | 9/26/2014 |
Change of Address or Employer Reporting Form | 3/1/2012 |
Continuing Education Class Log Monthly Report Form | 3/1/2012 |
Continuing Education Class Roster Form (NEW) | 1/8/2015 |
Continuing Education Provider (CEP) Application for Approval Form | 1/24/2012 |
Coroners Worksheet of Death - EMS Report of Death Protocol Reference #12010 | 9/13/2012 |
CQI FORM001 - Radio Communication Failure Notification | 6/1/2011 |
CQI FORM002 - Radio Communication Failure Investigation | 6/1/2011 |
CQI FORM003 - Paramedic Field Care Audit | 6/1/2011 |
CQI FORM004 - MICN Chart Audit | 6/1/2011 |
CQI FORM005 - Quality Improvement Log | 6/1/2011 |
CQI FORM006 - MICN Tape Evaluations Summary | 12/1/2011 |
CQI FORM007 - Quarterly Report | 6/1/2011 |
CQI FORM008 - Unusual Occurrence Confidential Case Review Request | 1/18/2018 |
CQI FORM009 - Confidential Case Review Evaluation | 6/1/2011 |
CQI FORM011 - Exceptional Performance Report | 6/1/2011 |
CQI FORM012 - Annual Report | 6/1/2011 |
CSAM Evaluation Form | 9/29/2011 |
DNR Do Not Resuscitate Form - Prehospital EMS Providers Official State Document | 1/1/2009 |
Drug Shortage Waiver Request Form | 5/16/2013 |
Duplicate Card Application | 1/17/2013 |
EMD Center Application | 9/24/2015 |
EMS Aircraft - Provision of Medical Control Permit Application | 5/24/2017 |
EMT / AEMT Supplemental CE Form | 9/11/2014 |
EMT Course Record | 10/2/2015 |
EMT Skills Verification Form | 7/1/2017 |
EMT Training Program Approval Packet | 6/9/2017 |
EMT-P Course Completion Record | 2/15/2018 |
EMT-P Training Program Approval Packet | 3/30/2016 |
Fireline Paramedic Deployment Notification Form (ICEMA Reference #6090) | 6/8/2015 |
Hospital Hub and/or Specialty Registry - Request for Access to View ePCRs | 10/4/2016 |
Live Scan Locations in Inyo County | 4/29/2014 |
Live Scan Locations in Mono County | 8/2/2011 |
Live Scan Locations in San Bernardino County | 8/24/2016 |
Live Scan Request Form - Advanced Emergency Medical Technician (AEMT) Certification | 2/22/2016 |
Live Scan Request Form - Emergency Medical Responder (EMR) Certification | 2/16/2016 |
Live Scan Request Form - Emergency Medical Technician (EMT) Certification | 2/16/2016 |
MICN Course Record | 9/10/2012 |
MICN Training Program Approval Packet | 9/10/2012 |
Personnel Authorized to Verify Skills Competency Request Form | 5/12/2015 |
POLST Form - Physician Orders for Life-Sustaining Treatment (EMSA #111B) | 1/1/2016 |
Provision of Medical Control - Information Form (for New Providers only) | 6/8/2016 |
Provision of Medical Control - Information Update Form | 6/8/2016 |
Quarterly Declaration | 8/8/2013 |
Special Event Ambulance Providers - SE Treatment Log Form | 8/9/2012 |
Specialty and Optional Scope Program Approval Application (ICEMA Reference #6060) | 7/1/2015 |
Submersion Incident Report Form SIRF (For Reporting all Drowning or Near Drowning Incidents in San Bernardino County) | 9/17/2013 |
Training Program and Continuing Education FY Annual Report Form | 2/5/2017 |