For more information call
EMS at (702) 759-1050
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Forms
The documents on this Web page are in Portable Document Format (PDF). You will need
Acrobat Reader
(a free application) to view and print these documents.
New Applicants
Instructions for Reciprocity Applicants
PDF (79 KB/1 page)
Instructions for Challenge Applicants
PDF (81 KB/1 page)
Application for EMT Certificate and/or Attendant License
PDF (88 KB/4 pages)
Instructions for Licensure Applicants
PDF (30 KB/2 pages)
Application for Initial Ambulance Permit
PDF (84 KB/6 pages)
Application for Authorization/Reauthorization as an EMS Training Center
PDF (133 KB/2 pages)
EMS Training Forms
Notice of Intent to Conduct EMS Training Course
PDF (31 KB/1 page)
Notice of Intent to Conduct EMS Continuing Medical Education (CME) Training
PDF (39 KB/1 page)
EMS Course Completion Record
PDF (39 KB/1 page)
Paramedic Didactic/Clinical Course Completion
PDF (36 KB/1 page)
Recertification Forms
First Responder Recertification Report
PDF (25 KB/2 pages)
EMT-Basic Recertification Report
PDF (29 KB/2 pages)
EMT-Intermediate Recertification Report
PDF (29 KB/2 pages)
EMT-Paramedic Recertification Report
PDF (32 KB/2 pages)
EMS Instructor Renewal Report
PDF (20 KB/1 page)
Skills Proficiency Record
PDF (49 KB/2 pages)
Application for Renewal of EMS Certification
PDF (76 KB/2 pages)
Application for Renewal of Ambulance Permit
PDF (81 KB/6 pages)
EMS Instructor/RN/PA Forms
Application for EMS Instructor Certification
PDF (43 KB/2 pages)
Monitoring Form for EMS Instructor Applicant
PDF (25 KB/1 page)
Physician Advisor Verification of EMS Registered Nurse
PDF (70 KB/2 pages)
Physician Advisor Verification of Physician’s Assistant
PDF (70 KB/2 pages)
Do Not Resuscitate (DNR) Forms
DNR I.D. and Information for Pre-Hospital EMS Personnel
PDF (90 KB/2 pages)
DNR Application & Instructions for Adults
PDF (123 KB/2 pages)
DNR Application & Instructions for Adults (Spanish)
PDF (123 KB/2 pages)
DNR Application & Instructions for Minors
PDF (121 KB/2 pages)
DNR Application & Instructions for Minors (Spanish)
PDF (120 KB/2 pages)
Other Forms
Exemplary Performance Recognition
PDF (17 KB/1 page)
Petition for New Drug/Equipment
PDF (21 KB/5 pages)
Submersion Incident Report
PDF (61 KB/1 page)
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