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:

T-7 Review and Retrain - EMT Practical Certification Examination
T-4 Initial Certification Program Completion Form 

*Please utilize the online EMS Education Approval System in place of a T-1 or T-2 form
Online EMS Education Approval System

For EMS Continuing Education Training Programs:

T-3 Physician Medical Director
T-5 Uniform CME Certificate
T-6 Uniform Skills Verification Certificate

Please see the List of OEMS Education Forms for a description and explanation for the above listed forms.

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

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
Expanded EMS Scope of Practice Application

Other Forms

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

Hospital Stroke Center Attestation Form 

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