Main Content
Article
Service Provider Certifications, Forms and Information
If you have questions regarding rules, equipment, or standards while filling out the applications please refer to the Title 836 rules found at: http://www.in.gov/dhs/3531.htm
836 Rule 1 – Information for all Providers, & BLS equipment list
836 Rule 2 – Additional Information for ALS Providers, Supervising Hospitals, & ALS
Equipment list
836 Rule 3- Air Ambulance Providers (fixed & rotor wing)
Emergency Vehicle Equipment Checklist-General
This checklist includes all of the mandated equipment to be carried on BLS and ALS vehicles. Please have ready only the equipment pertaining to your level of service.
Rescue Squad
Applications
Initial Application
Renewal Application
Information
Rescue Squad requirements & equipment list
BLS Non-transport Provider
Applications
Initial - BLS Service Provider Application
Renewal Application
Staff roster (also needs to be signed by Medical Director)
Medical Director Approval Form
Information
04 BLS Non-transport rules
Non-transport equipment list
BLS Non-Transport Equipment List
BLS Ambulance Provider
Applications
Initial - BLS Service Provider Application (new or upgrading service)
Renewal Application
Staff Roster (also needs to be signed by Medical Director)
Medical Director Approval Form
ALS Provider - Transport & Non-transport
Applications
Initial - ALS Service Provider Application (new or upgrading service)
Renewal Application
Staff roster (also needs to be signed by Medical Director)
Medical Director Approval Form
Information
ALS Non-transport Equipment List
Air Ambulance Provider
Applications
Inital & Renewal Application
Aircraft Application for Certification
Staff roster (also needs to be signed by Medical Director)
Medical Director Approval Form
BLS/ALS
Information
Air Ambulance Equipment List
Supervising Hospital
Applications
Inital & Renewal Application
Staff roster (also needs to be signed by Medical Director)
Note: On Section E 'approval of medical staff' means the CMO or Chief of Staff,
NOT the service or ED Medical Director.
Vehicle Certification & other forms
New or Replacement Vehicle Application
Vehicle Proof of Insurance Form
Vehicle Accident Reporting Form
Other Provider Forms
Blood & Body Fluid Exposure
Pre-hospital DNR
EMS Incident/Investigation Form
Physician Orders for Scope of Treatment (POST) guidance