Service Provider Certifications, Forms and Information
If you have questions regarding rules, equipment, or standards while filling out the applications please refer to the Title 836 rules found at: http://www.in.gov/dhs/3531.htm
836 Rule 1 – Information for all Providers, & BLS equipment list
836 Rule 2 – Additional Information for ALS Providers, Supervising Hospitals, & ALS
Equipment list
836 Rule 3- Air Ambulance Providers (fixed & rotor wing)
Emergency Vehicle Equipment Checklist-General
This checklist includes all of the mandated equipment to be carried on BLS and ALS vehicles. Please have ready only the equipment pertaining to your level of service.
- Rescue Squad
Applications
Initial Application
Renewal Application
Information
Rescue Squad requirements & equipment list
- BLS Non-transport Provider
Applications
Initial - BLS Service Provider Application
Renewal - BLS Service Provide Application
Staff roster (also needs to be signed by Medical Director)
Medical Director Approval Form
EMT-B (BLS) - EMT-B/A (BLS/ALS)
Information
04 BLS Non-transport rules
Non-transport equipment list
BLS Non-Transport Equipment List
- BLS Ambulance Provider
Applications
Initial - BLS Service Provider Application (new or upgrading service)
Renewal - BLS Service Provider Application
Staff Roster (also needs to be signed by Medical Director)
Medical Director Approval Form
EMT-B (BLS) - EMT-B/A (BLS/ALS)
- ALS Provider - Transport & Non-transport
Applications
Initial - ALS Service Provider Application (new or upgrading service)
Renewal - ALS Service Provider Application
Staff roster (also needs to be signed by Medical Director)
Medical Director Approval Form
BLS/ALS
Information
ALS Non-transport Equipment List
- Air Ambulance Provider
Applications
Initial & Renewal Application
Staff roster (also needs to be signed by Medical Director)
Medical Director Approval Form
BLS/ALS
Information
Air Ambulance Equipment List
- Supervising Hospital
Applications
Inital & Renewal Applications
Staff roster (also needs to be signed by Medical Director)
Note: On Section E 'approval of medical staff' means the CMO or Chief of Staff,
NOT the service or ED Medical Director.
- Vehicle Certification & other forms
New or Replacement Vehicle Application
Vehicle Proof of Insurance Form
Vehicle Accident Reporting Form
- Other Provider Forms
Blood & Body Fluid Exposure
Pre-hospital DNR
EMS Incident/Investigation Form
Online Services
- Electronic Filing Information
- Amusement & Entertainment Permit Application
- Building Plans - File on-line
- EMS on-line Certification Renewal
- Fire Safe Cigarettes
- Fireworks Permit Application
- Fireworks - Supervised Public Display Permit Application
- IDHS Training Calendar
- iGMS
- iGMS Training Tutorial
- Pay Fees on-line with Credit Card or e-Check
- PSID & Training / Certification Details
- WebEOC
- Website Customer Survey
- Forms.IN.gov
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