Emergency Medical Services Applications & Forms
Renewal Certification Application - Complete this application in order to recertify your state of Louisiana EMT card.
If your state EMT certification has lapsed as of March 31, you must complete a Reinstatement Application.
Reciprocity Form - This application must be completed if EMT training and/or testing was completed out of the State of Louisiana in order to transfer EMT certification from another state.
EMSCC Disclosure Form - All students must complete this form to be sent in with Initial Course Roster.
Examination Form - In order to register for the National Registry exam, please complete this form completely. Incomplete forms will be returned.
Certification Form - You must complete this form in order to practice as an EMT in the State of Louisiana.
Duplicate EMT Card - The Bureau of EMS requires this form in order to get a duplicate EMT card.
Rural AED Program Application - This Rural Access to Emergency Devices application must be completed by every organization applying for an AED. You must submit a separate application for each AED requested.
AED Notification & Summary Form - This form is to be completed by all entities in possession of an Automated External Defibrillator (AED) and submitted to the Bureau of EMS and your local EMS/Fire Dept. in order to comply with RS40:1236.13.
For assistance please contact: Tina Phagan (225) 925-1904 email@example.com