EMS Certification and Provider Licensing Statistics
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Texas Department of State Health Services Regulatory Philosophy: The purpose of this philosophical statement of the Texas Department of State Health Services is to give guidance to the regulatory programs within the department on the ideal manner of conducting state business.
EMS CERTIFICATION/LICENSURE FORMS
| Initial applications |
EMS personnel: ECA, EMT, Advanced EMT, EMT-P or LP
|
Apply Online
|
|
Texas Fingerprint Service Code Form |
PDF |
DPS- Procedure to Access Criminal History Record Information (CHRI)
|
PDF |
All applicants will be required to undergo an FBI fingerprint criminal history check.
|
| Inactive certification/licensure |
PDF |
Read procedure |
| Out-of-state reciprocity |
Apply Online
|
|
Supplemental Forms |
| ECA High School/GED Exemption- for candidates who meet volunteer criteria |
PDF |
| Address/Name change |
PDF |
| Rule Exemption- Request exemption from EMS rules |
PDF |
| Volunteer Sign-off form |
PDF |
| Wallet card replacement |
PDF |
| Advanced EMT replacement card |
PDF |
| EMS Criminal History Pre-Screening |
PDF |
EMS RECERTIFICATION/RELICENSURE FORMS
| Renewal Applications |
EMS personnel: ECA, EMT-basic, Advanced EMT, EMT-P or LP
|
Renew Online
|
| Inactive EMS certification/licensure |
PDF |
Read procedure |
| Volunteer-to-Paid Status Change- No longer exclusively a volunteer, you must pay cert fee |
PDF |
|
Supplemental Forms and Documents |
| Downgrade Statement form- Apply for lower level of certification |
PDF |
| Skills Proficiency Form for Late Renewal |
PDF |
EMS COMPLAINTS/CRIMINAL HISTORY FORMS
| Click for more information on complaints and criminal history |
| Complaint Form |
PDF
Word |
| Texas Service Code Fingerprint Form |
PDF |
| Criminal History Documentation Guide |
PDF |
| Community Supervision Form |
PDF |
| Criminal History Form |
PDF |
| Work History Form |
PDF |
|
Criminal History Report Form
- This form is intended for EMS certificants/licensees to self-report an arrest, indictment, charge, conviction, deferred adjudication community supervision, and/or deferred disposition
|
PDF |
DPS- Procedure to Access Criminal History Record Information (CHRI)
|
PDF |
|
EMS Criminal History Pre-Screening
- This form is intended for evaluating criminal history prior to taking an EMS course to determine eligibility for EMS certification
|
PDF |
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EMS COORDINATOR/INSTRUCTOR/EDUCATION PROGRAM FORMS
| Initial and Renewal Applications |
| Initial coordinator, instructor and information operator instructor |
PDF |
Process |
| Renewal coordinator, instructor and information operator instructor |
PDF |
Process |
| Educator Fee Exemption |
PDF |
| Education Program Forms |
|
EMS Education Program forms can now be found
here. |
|
EMS PROVIDER GUIDELINES
| To find the nearest regional office,
click here . |
|
The Clinical Laboratory Improvement Act (CLIA) of 1988 established licensing requirements for facilities (including EMS firms) performing lab tests. Even simple tests such as blood glucose testing and monitoring fall under the CLIA requirements. Fortunately, those simple tests that are commonly performed on EMS units qualify for a CLIA Certificate of Waiver. Effective September 1, 2004, EMS Providers will be responsible for securing and maintaining a current CLIA Certificate of Waiver. This applies to any firm using glucometers or other devices to test blood or other patient fluids. |
Information |
| Surety Bond Form for EMS |
PDF |
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REGIONAL ADVISORY COUNCIL DEVELOPMENT
| Documents |
| Rule Interpretation: Regional Trauma Treatment Protocols as a component of the EMS/Trauma System Plan
|
PDF |
| Texas Trauma System Power Point Presentation |
Self-extracting zip file |
| EMS/Trauma System Plan: A Supplement to the Texas Trauma System Manual |
PDF |
| Regional needs assessment (HOTRAC) |
PDF |
|
Facility Resource Capability Form (Coastal Bend RAC) (external site) |
|
Systems Quality Concern Form (Coastal Bend RAC) (external site) |
| Affidavit Acknowledging Utilization of RAC Regional Protocols Regarding Patient Destination and Transport |
PDF |
|
EMS and Trauma Care System Account and Emergency Medical Services, Trauma Facilities, and Trauma Care System Fund &
Designated Trauma Facility and Emergency Medical Services Account Documents |
| EMS/Trauma Care System Account- report to the 77th Legislature (2001) |
PDF |
| EMS/RAC Expenditure Report Form |
Excel |
|
FY19 EMS/CO-RAC REPORTING TEMPLATES for the period of 5/1/2018 through 8/31/2019
FY19 EMS/CO-RAC Reporting Calendar
FY19EMS/RAC Categorical Budget of Anticipated Expenditures
FY19 EMS/RAC Narrative
FY19 EMS/County Distribution Plan
FY19 EMS/CO-RAC Supporting DocumentationExcel
|
Excel
Excel
Word
Excel
Excel
|
|
EMS/RAC REPORTING TEMPLATES
for 5/1/2018 through 8/31/2019
EMS/RAC - Categorical Budget – Anticipated Expenditures
EMS/RAC - Narrative
EMS/TOB & RAC - Support Documentation (Template has two tabs)
EMS Provider Expenditure Report Form
EMS Provider Summary Report
EMS/RAC & EMS/TOB-RAC Final Narrative Report
|
Excel
Word
Excel
Excel
Excel
Word |
RAC Annual Report Form
|
Word |
B-13 template
|
Word |
Board Responsibilities Attestation Form
|
Word |
Email reports to:
|
CMUReg.svcs@dshs.state.tx.us
|
Mail reports to:
|
Department of State Health Services
P.O. Box 149347
Austin, Texas 78714-9347, MC 1990
Attention: Norma Six |
MATERNAL FACILITY DESIGNATION
LEVEL I FORMS
|
Complete Application for Level I Designation
|
PDF |
Level I Self-Survey Report
|
PDF |
Sample Attestation
|
PDF |
| LEVEL II-IV FORMS |
|
Complete Application for Level II-IV Designation
|
PDF |
NEONATAL FACILITY DESIGNATION
LEVEL I FORMS
|
Complete Application for Level I Designation
|
PDF |
Level I Self-Survey Report
|
PDF |
Sample Attestation
|
PDF |
LEVEL II-IV FORMS
|
|
Complete Application for Level II-IV Designation
|
PDF
|
STROKE FACILITY DESIGNATION
| COMPREHENSIVE (LEVEL I) AND PRIMARY (LEVEL II)
FORMS |
|
Complete Application for Comprehensive (Level I) and Primary (Level II) Designation |
PDF |
|
RESOURCE DOCUMENTS |
Application Submission Instructions
|
PDF |
Helpful Information
|
PDF |
Frequently Asked Questions
|
PDF |
|
Policy and Procedure- Facility with Conditional Certification as Primary Stroke Center and De-Certification with The Joint Commission, Det Norske Veritas (DNV), or Healthcare Facilities Accreditation Program (HFAP) |
PDF |
| Guidance for Change of Legal Owner of a Hospital Facility (CHOW) and/or Change in Physical Location of a Hospital Facility and/or Impact to Stroke Facility Designation |
PDF |
TRAUMA FACILITY DESIGNATION
| ALL TRAUMA LEVELS |
| Complete Trauma Facility Designation Application |
PDF |
|
RESOURCE DOCUMENTS |
Application Submission Instructions
|
PDF |
Helpful Information
|
PDF
|
Frequently Asked Questions
|
PDF
|
|
Guidance for Change of Legal Owner of a Hospital Facility (CHOW) and/or Change in Physical Location of a Hospital Facility and/or Impact to Trauma Facility Designation |
PDF |
| ADVANCED (LEVEL III) |
| Process for Level III Trauma Facility Designation Application |
Webinar |
| Guidance on Essential Criteria for Level III Trauma Facility Designation |
PDF |
| Criteria Checklist for Level III Trauma Facility Designation |
PDF |
| Audit Filters for Level III Trauma Facility Designation |
PDF |
| Standards of Care for Level III Trauma Facility Designation |
PDF |
|
ADDITIONAL RESOURCE DOCUMENTS |
| Requirements for Trauma Facility Designation Surveyors |
PDF |
| Trauma Designation Survey Process |
PDF |
| Initial/Re-designation Level III Agenda Format |
PDF |
| Trauma Designation Upgrade |
PDF |
| Policy – Late Applications |
PDF |
| Frequently Asked Question Regarding Trauma |
PDF |
| BASIC (LEVEL IV) TRAUMA FACILITY DESIGNATION |
| Process for Level IV Trauma Facility Designation Application |
Webinar
|
| Guidance on Essential Criteria for Level IV Trauma Facility Designation |
PDF |
| Criteria Checklist for Level IV Trauma Facility Designation |
PDF |
| Audit Filters for Level IV Trauma Facility Designation |
PDF |
| Standards of Care for Level IV Trauma Facility Designation |
PDF |
|
ADDITIONAL RESOURCE DOCUMENTS |
| Requirements for Trauma Facility Designation Surveyors |
PDF |
| Trauma Designation Survey Process |
PDF |
| Initial/Re-designation Level IV Agenda Format |
PDF |
| Trauma Designation Upgrade |
PDF |
| Frequently Asked Question Regarding Trauma |
PDF |
| Policy – Late Applications |
PDF |
EMS/TRAUMA OPEN RECORDS
MATERNAL DESIGNATION
|
|
Designated Maternal Centers |
PDF |
| NEONATAL DESIGNATION |
|
Designated Neonatal Centers |
PDF |
| TRAUMA CENTER DESIGNATION |
|
Designated Trauma Centers |
PDF |
| STROKE CENTER DESIGNATION |
|
Designated Stroke Centers |
PDF |
EMS rosters are provided for informational purposes only.
Do not use these rosters to verify the current status of a license - please use our live online search, or contact the board/program office. The rosters on this page are provided in PDF and Excel, a format that can be downloaded, saved and manipulated on your computer. Making changes to a downloaded file will not result in any changes to the posted rosters, which are stored on our secure web server. The rosters are updated infrequently (generally, on a quarterly basis), and each roster lists the date it was created. |
| EMS CE PROGRAMS |
EXCEL
|
| CE PROGRAMS OFFERING JURISPRUDENCE EXAM |
|
EXCEL |
| EMS COURSES |
|
EXCEL |
| EMS EDUCATION PROGRAMS |
EXCEL
|
| EMS FIRST RESPONDER ORGANIZATIONS |
EXCEL
|
| EMS PROVIDERS AGENCIES |
EXCEL
|
| EMS PROVIDERS SUPPLEMENT |
EXCEL
|
EMS CERTIFICATION AND PROVIDER LICENSING STATISTICS
|
|
HTML |
| EMS ADMINISTRATOR OF RECORD COURSE COMPLETED LIST |
|
EXCEL |
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Once the files have been uncompressed, these document files will be in one of the following formats.
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.pdf (personal document file) which is viewable with the Adobe Acrobat Reader
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.txt (delimited text) which will import into most spread sheet programs
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.wpd (WordPerfect document) which is viewable with Wordperfect 6.1 or later or Word 97 or later
For more information contact your regional office.
Go to the regional map