Emergency Medical Service Unit Downloads Applications and Forms

Link to Certification Database

For additional information on Alaska EMS Certification email ems.certification@alaska.govor call 907-465-3029.

Forms for Individuals:

Course Forms

• EMS Course Approval (08/02)
• MICP Initial Course Approval (12/02)
• Instructor Course Approval (08/02)
• EMS Course Completion(04/03)

Certification Forms

• Initial Certification (9/07)
• Recertification (9/07)
• Venipuncture Form for Certification as an EMT-II (02/05)
• Application for Comity Certification (9/08)
• Emergency Medical Dispatcher Initial (9/07)
• Emergency Medical Dispatcher Recertification (9/07)
• Extension Request (10/05)

Course Prerequisites

• Proof of Patient Contacts EMT-II Candidates (10/02)
• Proof of Patient Contacts EMT-III Candidates (10/02)
• Patient Contact Form for EMT-II Candidates (9/05)
• Patient Contact Form for EMT-III Candidates (9/05)
• Medical Director Verification for EMT-II Candidates (08/02)
• Medical Director Verification for EMT-III Candidates (08/02)
• Venipuncture Form for entry into EMT-III Training Programs (12/05)

Instructor Certification Forms

• ETT Instructor Initial (9/07)
• ETT Instructor Recertification (9/07)
• EMT-I Instructor Initial (9/07)
• EMT-II/III Instructor Initial (9/07)
• EMT-I Instructor Recertification (9/07)
• EMT-II/III Instructor Recertification (9/07)
• Medevac Escort Instructor Initial (9/07)
• Reauthorization for Air Medical Escort Instructor (9/08)
• MICP Course Coordinator Initial (1/08)
• MICP Course Coordinator Recertification (9/07)

Frequently Asked Questions about Certification

• Conviction FAQs
• General FAQs

Forms for Services:

• Basic and Advanced Life Support Ground EMS Unit Application (8/05)
• Medevac Air Medical Service Application (8/05)
• Critical Care Air Ambulance Service Application (8/05)
• Specialty Air Medical Transport Team Application (7/05)

PCR:

• State of Alaska Model Pre-hospital Patient Report Form (5/99)

Mandatory Reporting:

• Mandatory Reporting - FAQs (12/03)
• Mandatory Reporting - DPS Burn Form

Expanded Scope
Click here to read more about Expanded Scope of Practice: Adding Additional Medications or Procedures for EMTs.

• Application for Expanded Scope (7/05)
• Expanded Scope Renewal Application (7/05)

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