{"id":233,"date":"2016-05-12T20:38:10","date_gmt":"2016-05-12T20:38:10","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/emergency-medical-services\/?page_id=233"},"modified":"2024-02-07T10:58:58","modified_gmt":"2024-02-07T15:58:58","slug":"ems-agency-application-package","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/emergency-medical-services\/ems-agency-application-package\/","title":{"rendered":"EMS Agency Application Package"},"content":{"rendered":"<p align=\"justify\">The documents, information and forms on this page are for use by persons interested in becoming licensed as an Emergency Medical Service (EMS) agency and for entities that wish to renew their EMS agency license. All required forms must be accurate and complete prior to submission to the local Office of EMS Program Representative.\u00a0 The Office of EMS Program Representative in your area is the primary contact if you have additional questions or require further information. In addition, please feel free to contact the Office of EMS at 1-800-523-6019 and speak with a representative from the Division of Regulation and Compliance staff.<\/p>\n<p>Vehicle Checklist<\/p>\n<ul>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/23\/2016\/05\/Non-TransportVehicleChecklist.pdf\">Non-Transport Vehicle Checklist<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/23\/2016\/05\/TransportVehicleChecklist.pdf\">Transport Vehicle Checklist<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/23\/2016\/05\/NeonatalVehicleChecklist.pdf\">Neonatal Vehicle Checklist<\/a><\/li>\n<\/ul>\n<p>Air Medical Checklist<\/p>\n<ul>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/23\/2016\/05\/Air-Medical-Workbook-V4.pdf\">Aeromedical Workbook Packet<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/23\/2016\/05\/Rotor-Wing-Vehicle-Checklist-rev-4-7-20.pdf\">Rotor Wing Vehicle Checklist<\/a><\/li>\n<\/ul>\n<p>Becoming An EMS Agency<\/p>\n<ul>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/23\/2024\/02\/2024-Becoming-EMS-Agency-in-Virginia.pdf\">Becoming An EMS Agency<\/a><\/li>\n<\/ul>\n<p>Program Representative Information<\/p>\n<ul>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/emergency-medical-services\/program-representatives\/\">Contact Information<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/23\/2016\/05\/RepAreas.pdf\">Regional Map<\/a><\/li>\n<\/ul>\n<p><a href=\"http:\/\/www.vaems.org\/\">Regional Council Contact Information<\/a><\/p>\n<p>OMD Information<\/p>\n<ul>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/23\/2016\/05\/Sample-OMD-Agreement1.pdf\">OMD Requirement with Sample Agreement<\/a><\/li>\n<li><a href=\"https:\/\/vdhems.vdh.virginia.gov\/emsapps\/f?p=EMSWEB:9\">OMD Endorsement Application<\/a><\/li>\n<\/ul>\n<p><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/23\/2016\/05\/VehicleLiabilityCoverageRequirments.pdf\">Vehicle Liability Requirements<\/a><\/p>\n<p><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/23\/2016\/05\/evoc-1.pdf\">Approve EVOC Course Memorandum<\/a><\/p>\n<p>Pre-Hospital Patient Care<\/p>\n<ul>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/23\/2016\/05\/EMSMedicalRecordSAMPLE.pdf\">EMS Medical Record Form &#8211; Sample<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/23\/2016\/05\/OrderForm-EMSMedicalRecord.pdf\">EMS Medical Record Order Form<\/a><\/li>\n<\/ul>\n<p>IRS Tax Exempt Letter &#8211; Sample (missing)<\/p>\n<p><a href=\"http:\/\/law.lis.virginia.gov\/admincode\/title12\/agency5\/chapter31\/\">Regulations Governing EMS <\/a><\/p>\n<div class=\"RowWithColumns_No_Float\"><\/div>\n","protected":false},"excerpt":{"rendered":"<p>The documents, information and forms on this page are for use by persons interested in becoming licensed as an Emergency Medical Service (EMS) agency and for entities that wish to [&hellip;]<\/p>\n","protected":false},"author":69,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"tags":[],"class_list":["post-233","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - 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