Forms and Applications

Complaints/Investigations

This is a form to submit a complaint regarding quality of care, fraudulent credentials or other misconduct by a healthcare provider.  If you prefer to have this form mailed to you, please call 860-509-7975.
 

EMS Instructor Course Forms


Forms for EMS Instructors applying to conduct training courses (Please see OEMS Education and Training for more information)

For Initial Certification Training Programs:
 
For Recertification Training Programs:

 

EMS Provider Licensing & Certification Applications

Please visit our Licensing & Certification page for more information and instructions to apply for certification and licensure for all clinical EMS providers.  Below you will find forms for currently certified or licensed EMS providers.

Name or Address Change form
Request to change from AEMT to EMT certification form   

 

EMS Organization Forms

Forms and applications for organizations to apply for new or expanded services, PSAR designation, change in authorization, new vehicles, change in sponsor hospital, or to add authorized skills. 

BLS Skills & MIC Signature Page
Change of Principal or Branch Location Form
Emergency Vehicle Short-Form Application
MIC Authorization Application
Municipality Request to change PSAR
Need for New or Expanded Services Application
Recognition of Supplemental First Responder Status Application
Primary Service Area Responder Application
Primary Service Area/First Responder Combination Application
Sale or Transfer of PSA Application
Sponsor Hospital Change Form 

Other Forms

These are forms for use by a hospital, municipality or other non-EMS organization.



Please Note: Adobe Acrobat Reader is needed in order to view and print the Portable Document Format (pdf) files.