EMS Provider Licensing
DSHS would like you to complete a short online survey at: https://www.surveymonkey.com/r/RLUsurvey The information provided assists DSHS to continually improve and be more responsive to the needs of customers.
FIRST RESPONDER ORGANIZATIONS
For information and forms visit the First Responder Registration information page.
For additional help or if you have questions about EMS First Responder forms or processing contact 512-834-6734.
Texas Administrative Code 157.11, Requirements for an EMS Provider License
Texas Administrative Code 157.3, Processing EMS Provider Licenses and Applications
Texas Administrative Code 157.12, Rotor-wing Air Ambulance Operations
Texas Administrative Code 157.13, Fixed-wing Air Ambulance Operations
FORMS AND DOCUMENTS
Use the following checklist as a guide regarding required documentation and elaboration of each provider licensing requirement.
EMS Provider Initial Survey Checklist
EMS Provider Compliance Survey Checklist
EMS Provider Survey FAQs
EMS Quality Assurance Plan Tool
Virtual Inspections/Surveys Procedure
Administrator of Record
Administrator of Record renewal
EMS Provider Declaration Form
EMS Personnel Form
EMS Station Location List
EMS Headquarters Physical Location Change
EMS Vehicle Form
Medicaid Surety Bonds for Ambulance Providers
Medical Director Form
Notifications / Changes Form
Replacement License / Authorization Form
Variance Request Form
Please note that money mail is to be submitted to a different address than submittals without payment.
Mailed/Overnight Fee Payments
Use/Submit the below linked cover sheet and address for mailed/overnight fee payments:
Cover Sheet - Mailed/Overnight Documents Containing Fee Payments
Submission with No Fee
Use one of the links below for the appropriate cover sheet and address for any submission with no fee payment:
For help or questions about EMS Provider forms or processing call:
Judy Gilbert: 512-231-5771
Kelly Boudreaux: 512-231-5725
Terry Smith 512-834-6725
Douglas Emberton 512-834-6735
For technical assistance contact your local field office. You can find a list of offices at: Regional Office Contact Information