APPLICATION FOR INITIAL APPROVAL OF AN EMERGENCY MEDICAL SERVICES (EMS) TRAINING PROGRAM - Florida Department of Health Bureau of Emergency Medical Oversight

Oct 5, 2026

Uploaded by Damian

Application form for initial approval of an Emergency Medical Services (EMS) training program administered by the Florida Department of Health, Bureau of Emergency Medical Oversight. The form collects applicant type (EMT or Paramedic) and whether the program is public or non-public, plus required permissible attachment omissions. It requires primary training location and program leadership details, clinical hospital/facility affiliations, EMS provider affiliation agreements, a structured program of study with contact hours and prerequisites, and attachments 1–11 covering licensing, curricula, agreements, phase-one requirements, trauma scorecard and SUID training, and faculty documentation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Part I: Name and Program Information

Primary Training Location and Program Director/CEO Details

Part II: Affiliations, Program of Study, and Attachments

Hospital/Facility Affiliations

EMS Provider Affiliation(s)

Program of Study and Contact Hours

Prerequisites or Co-requisites

Faculty Requirements

Attachments 1–11

STATE OF FLORIDA DEPARTMENT OF HEALTH BUREAU OF EMERGENCY MEDICAL OVERSIGHT APPLICATION FOR INITIAL APPROVAL OF AN EMERGENCY MEDICAL SERVICES (EMS) TRAINING PROGRAM (Type or print-illegible applications will not be processed) Select only one: ☐ EMT ☐ Paramedic Select only one: ☐ Public ☐ Non-Public (Private) Permissible attachment omissions: Public EMT EMS Training Programs may omit attachment 1 and attachment 6. Non-Public EMT EMS Training Programs may omit attachment 6. Public paramedic EMS Training Programs may omit attachment 1. Non-Public paramedic EMS Training Programs may not omit any attachments. PART I: Name of EMS Training Program: Address of EMS Training Program: Name of Chief Executive Officer: | Primary Training Location: | | --- | | Name of Program Director (PD): | | Telephone Number of PD: | Email of PD: Program Website (if applicable): 1. Attachment 1 (Non-Public EMS Training Programs): Provide a current license issued by the Florida Department of Education, Commission for Independent Education. PART II: 1. Hospital/Facility Affiliations: required to conduct clinical training | Hospital/Facility | Address | | --- | --- | | | | | | | | | | | | | | | | | | | | | | | | | | | | DH 1698, 05/2024, incorporated by reference in Rule 64J‐1.020 F.A.C. Form referenced from section 401. 2701, Florida Statutes | | | | --- | --- | | | | 2. EMS Provider Affiliation(s) Paramedic programs must maintain at least one (1) agreement with a licensed advanced life support (ALS) primary 911 response and transport provider; EMT programs must maintain at least one (1) agreement with a licensed basic life support (BLS) primary 911 response and transport provider . | EMS Provider | License Number | | --- | --- | | | | | | | | | | | | | | | | | | | | | | | | | Attachment 2: Provide the current written agreement or contract for all hospitals and EMS providers affiliated with the training program. Training programs that are also licensed ALS EMS providers with permitted transport vehicles are not required to submit affliation agreements with other EMS providers. 3. Program of Study a. Attachment 3: Provide a comprehensive list and skill sheets of psychomotor skills required to complete the EMS training class. b. Contact hours of each class component: | Didactic: | Skills Practice Lab: | | --- | --- | | Clinical Internship: | Other: | | Field Internship: | Total Contact Hours: | c. Specify below all pre-requisites or co-requisites to the program, if any: ☐ At least 18 Years of Age ☐ Physical Fitness Test ☐ Mental Fitness Test ☐ Field Experience- If so, please include the years/months of filed experience required prior to entry into the program: ☐ Drug Screen ☐ Level II Background Check ☐ Postsecondary Education Readiness Test (P.E.R.T.) Minumum Writing Score Minmum Math Score Minmum Reading Score ☐ General Biology (BSC1005) ☐ General Biology Lab (BSC1005L)☐ General Biology (BSC1010) ☐ Human Biology (BSC1020)☐ Human Anatomy and Physiology (BSC1084) ☐ Human Anatomy and Physiology Lab (BSC1084L) ☐ Anatomy and Physiology I (BSC2085) ☐ Anatomy and Physiology I Lab (BSC2085L) ☐ Anatomy and Physiology II (BSC2086) DH 1698, 05/2024, incorporated by reference in Rule 64J‐1.020 F.A.C. Form referenced from section 401. 2701, Florida Statutes ☐ Anatomy and Physiology II Lab (BSC2086L) ☐ Anatomy and Phyiology I (BSC2093) ☐ Anatomy and Phyiology II (BSC2094)☐ Basic Chemistry Concepts and Applications 1 (CHM1030) ☐ Basic Chemistry Concepts and Applications 2 (CHM1031) ☐ General Chemistry (CHM1032 or 1033)☐ General Chemistry I (CHM2045)☐ General Chemistry I Lab (CHM2045L)☐ Developmental English (ENC1001) ☐ Developmental English (ENC1010) ☐ Developmental English II (ENC1012) ☐ Developmental English (ENC1030) ☐ College Algebra (MAC1105) ☐ Other: Please Specify __________________________________ ___________

FAQs

How do you indicate whether the EMS training program is EMT or Paramedic?

The application requires selecting only one option for EMT or Paramedic using the provided checkboxes.

What documentation is required for hospital/facility and EMS provider affiliations?

Hospital/Facility affiliations are listed in Part II, Section 1, and EMS provider affiliation agreements must be provided in Section 2. Attachment 2 requires the current written agreement or contract for all affiliated hospitals and EMS providers, with an exception for certain ALS EMS providers that already have permitted transport vehicles.

What must be included for paramedic programs in Phase One?

Attachment 6 must provide documentation that clearly describes the course content students must complete for phase one of the paramedic EMS training class.

Oct 5, 2026

Uploaded by Damian