EMS Provider Licensing

Complete our Survey

DSHS would like you to complete a short online survey. 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.

Rules and Policies

• EMS Trauma Systems Rules
• EMS Trauma Systems Policies

Forms and Documents

Applications

• Provider Licensing Application
• Online Licensing (renewal only)

Checklists
Use the following checklist as a guide regarding required documentation and elaboration of each provider licensing requirement.  

• EMS Provider Initial License Checklist
• EMS Provider Renewal License Checklist
• EMS Provider Initial Survey Checklist
• EMS Provider Survey FAQs
• EMS Quality Assurance Plan Tool
• Virtual Inspections/Surveys Procedure

Licensing Forms

• 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
• Subscription Program Surety Bond
• Medicaid Surety Bonds for Ambulance Providers
• Medical Director Form
• Notifications / Changes Form
• Replacement License / Authorization Form
• Variance Request Form

Notices and Signs

• Consumer Complaint Notice
• EMS Vehicle Out of Service Sign

Fees
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: