[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-368151-105":3,"detail-sidebar-cat-0-en-105":80,"doc-detail-368151-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","902-a-advanced-emt-aemt-skills-competency-verification-form","902-A - Advanced EMT (AEMT) Skills Competency Verification Form","","Advanced EMT (AEMT) Skills Competency Verification Form (EMSA-AEMT SCVF) used in California to document verification of an AEMT’s demonstrated skills for recertification. The form lists competency items including injection (IM/SQ), peripheral IV, IV push medication, inhaled medication, blood glucose determination, and peri/laringeal airway adjunct. Instructions require completing identifiers, certifying authority, verification signatures, dates, and printed verifier names, with verification valid up to two years from the verification date.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/exam/","Exam",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/902-a-advanced-emt-aemt-skills-competency-verification-form/368151/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/902-a-advanced-emt-aemt-skills-competency-verification-form/368151.png","ImageObject",300,407,{"name":42,"@type":43},"Grenda","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-09","2026-09-23",true,{"@type":52,"interactionType":53,"userInteractionCount":26},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"When is an AEMT Skills Competency Verification Form required?","Question",{"text":62,"@type":63},"It is required to accompany an AEMT recertification application for individuals either maintaining AEMT certification without a lapse or renewing with a lapse less than twenty-four months.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"Which skills are listed for competency verification?",{"text":67,"@type":63},"The form includes injection (IM or SQ), peripheral IV, IV push medication, inhaled medication, blood glucose determination, and peri/laringeal airway adjunct.",{"name":69,"@type":60,"acceptedAnswer":70},"How should the verifier document competency for each skill?",{"text":71,"@type":63},"After competency is demonstrated by direct observation of an actual or simulated patient contact, the verifier signs the AEMT Skills Competency Verification Form for that skill and records affiliation, certification/license number, date, and print name.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},368151,1790175290,{"code":4,"msg":81,"data":82},"success",[83,87,91,94,99,104,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":88,"show_sort_weight":89,"slug":90},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":92,"slug":93},70,"exam",{"id":95,"doc_module":4,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},5,"Comic",60,"comic",{"id":100,"doc_module":4,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},6,"Technology",50,"technology",{"id":105,"doc_module":4,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},7,"Healthcare",40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":95,"slug":129},19,"General","general",{"code":4,"msg":81,"data":131},{"doc_id":78,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":33,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":26,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":26,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":79,"read_time":95,"preview_page_count":4},7971474921005,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","State of California  \nAdvanced EMT (AEMT) Skills Competency Verification Form EMSA-AEMT SCVF (01/07)  \nInstructions for completing located on the back of this form  \n\n| 1a. Name as shown on AEMT Certificate |  | 1b. Certificate Number | 1c. Signature |  |\n| --- | --- | --- | --- | --- |\n| 1d. Certifying Authority |  | 1e. Date | I certify, under the penalty of perjury, that the information contained on this form is accurate. |  |\n| Skill | Verification of Competency |  |  |  |\n| 1. Injection (IM or SQ); | Affiliation |  |  | Date |\n| Signature of Person Verifying Competency | Print Name |  |  | Certification / License Number |\n| 2. Peripheral IV | Affiliation |  |  | Date |\n| Signature of Person Verifying Competency | Print Name |  |  | Certification / License Number |\n| 3. IV Push Medication | Affiliation |  |  | Date |\n| Signature of Person Verifying Competency | Print Name |  |  | Certification / License Number |\n| 4. Inhaled Medication | Affiliation |  |  | Date |\n| Signature of Person Verifying Competency | Print Name |  |  | Certification / License Number |\n| 5. Blood Glucose Determination | Affiliation |  |  | Date |\n| Signature of Person Verifying Competency | Print Name |  |  | Certification / License Number |\n| 6. Perilaryngeal Airway Adjunct | Affiliation |  |  | Date |\n| Signature of Person Verifying Competency | Print Name |  |  | Certification / License Number |\n\nA completed AEMT Skills Verification Form is required to accompany an AEMT recertification application for those individuals who are either maintaining AEMT certification without a lapse or to renew an AEMT certification with a lapse in certification less than twenty-four (24) months.  \n1a. Name of Certificate Holder  \nProvide the complete name, last name first, of the AEMT certificate holder who is demonstrating skills competency.  \n1b. Certificate Number  \nProvide the AEMT certification number from the current or lapsed AEMT certificate of the AEMT certificate holder who is demonstrating competency.  \n1c. Signature  \nSignature of the AEMT certificate holder who is demonstrating competency. By signing this section the AEMT is verifying that the information contained on this form is accurate and that the AEMT certificate holder has demonstrated competency in the skills listed to a qualified individual.  \n1d. Certifying Authority  \nProvide the name of the AEMT certifying authority to which the individual will be applying for AEMTrecertification.  \nVerification of Competency  \n1. Affiliation-Provide the name of the training program or EMS service provider that the qualified individual who is verifying competency is affiliated with.  \n2. Once competency has been demonstrated by direct observation of an actual or simulated patient contact, i.e. skills station, the individual verifying competency shall sign the AEMT Skills Competency Verification Form (EMSA-AEMT SCVF (01/07)) for that skill.  \n3. Qualified individuals who verify skills competency shall be currently licensed or certified as:  \nAn AEMT , Paramedic, Registered Nurse, Physician Assistant, or Physician and shall be either a qualified instructor designated by an EMS approved training program (AEMT training program, paramedic training program or continuing education training program) or by a qualified individual designated by an EMS service provider. EMS service providers include, but are not be limited to, public safety agencies, private ambulance providers, and other EMS providers.  \n4. Certification or License Number – Provide the certification or license number for the individual verifying competency.  \n5. Date-Enter the date that the individual demonstrates competency in each skill.  \n6. Print Name – Print the name of the individual verifying competency in the skill.  \nVerification of skills competency shall be valid to apply for AEMT recertification for a maximum of two years from the date of verification.","cbCaio5ViCskX6NA","https://ap.wps.com/l/cbCaio5ViCskX6NA","pdf",62436,"English","# Skills Competency Verification Form\n## Covered Skills\n## Eligibility for Recertification and Validity","[{\"question\":\"When is an AEMT Skills Competency Verification Form required?\",\"answer\":\"It is required to accompany an AEMT recertification application for individuals either maintaining AEMT certification without a lapse or renewing with a lapse less than twenty-four months.\"},{\"question\":\"Which skills are listed for competency verification?\",\"answer\":\"The form includes injection (IM or SQ), peripheral IV, IV push medication, inhaled medication, blood glucose determination, and peri/laringeal airway adjunct.\"},{\"question\":\"How should the verifier document competency for each skill?\",\"answer\":\"After competency is demonstrated by direct observation of an actual or simulated patient contact, the verifier signs the AEMT Skills Competency Verification Form for that skill and records affiliation, certification/license number, date, and print name.\"}]","902-A - Advanced EMT (AEMT) Skills Competency Verification Form | PDF"]