DHSS State of Alaska

Forms & Publications

• Applications & Forms
• EMS for Children
• EMS Directory
• Publications
• Instructor Resources
• Medevac Resources
• Model Operating Guidelines
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• Statutes, Regs and Policies
• Treatment Guidelines
• Bioterrorism Resource Guide, Oct. 2003

Other Resources

• Disaster
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Emergency Medical Services Unit
Forms and Applications

• Link to Certification Database

For additional information on Alaska EMS Certification email ems.certification@alaska.gov or 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 (10/09)
• Recertification (10/10)
• Venipuncture Form for Certification as an EMT-II (02/05)
• Application for Comity Certification (10/09)
• Emergency Medical Dispatcher Initial (10/09)
• Emergency Medical Dispatcher Recertification (10/09)
• Extension Request (01/12)

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 (10/09)
• ETT Instructor Recertification (10/09)
• EMT-I Instructor Initial (10/09)
• EMT-II/III Instructor Initial (10/09)
• EMT-I Instructor Recertification (10/09)
• EMT-II/III Instructor Recertification (10/09)
• Medevac Escort Instructor Initial (9/07)
• Reauthorization for Air Medical Escort Instructor (9/08)
• MICP Course Coordinator Initial (10/09)
• MICP Course Coordinator Recertification (10/09)

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

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)

Section of
Emergency Programs

• Emergency Programs Home
• About Emergency Programs
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Preparedness

• About Preparedness
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Emergency Medical Services (EMS)

• EMS Home
• About EMS
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• EMS Certification
• EMS Programs
• Forms and Publications
• Training
• Alaska Council on EMS

Trauma System

• About the Trauma System
• Trauma Center Designation
• Trauma Training
• Alaska Trauma Registry