CME Submission Portal

The Continuing Medical Education (CME) Recertification Program is a state-wide recertification option that allows a Certified First Responder (CFR), Emergency Medical Technician (EMT), Advanced Emergency Medical Technician (AEMT), Emergency Medical Technician – Critical Care (EMT- CC), or Paramedic to renew certification without the need to complete a cognitive or psychomotor certification examination. Please use the following form below to submit the required materials for the CME Recertification Program.

The AC3253-S and other information can be found on our website at: http://www.health.ny.gov/nysdoh/ems/main.htm. If you have questions regarding submission of vouchers, please contact our Funding Unit at (518) 402-0996.

Entity Submitting (Choose One)

EMS Agency

Course Sponsor

Is this a Re-Submission?

Yes

Please enter you previous Submission ID (SID) Number:

EMS Agency Submission

Submission of a CME Recertification Application on this page means you are, the agency’s CME Coordinator or, you are an individual submitting your own application and the recertification is sponsored by an agency.

Contact Information for EMS Agency

First Name

Last Name

Phone

Please verify that the above email address is correct.

This email address will be used to send a confirmation notice as well as a copy of this submission.

Please Confirm Email

EMS Agency Name

EMS Agency Code

Level of Care for Submission

All certified providers submitted for renewal on this submission must be from the same level of care.

CFR Applicant(s) Submission(s)

First Name	Last Name	Expiration Date	EMT Number	DOH-5295 CFR Recertification Form	CPR Card
First Name	Last Name	Expiration Date	EMT Number	DOH-5295 CFR Recertification Form Upload requirements	CPR Card Upload requirements

more items

EMT-B Applicant(s) Submission(s)

First Name	Last Name	Expiration Date	EMT Number	DOH-5065 EMT-B Recertification Form	CPR Card
First Name	Last Name	Expiration Date	EMT Number	DOH-5065 EMT-B Recertification Form Upload requirements	CPR Card Upload requirements

more items

AEMT Applicant(s) Submission(s)

First Name	Last Name	Expiration Date	EMT Number	DOH-5067 AEMT Recertification Form	CPR Card
First Name	Last Name	Expiration Date	EMT Number	DOH-5067 AEMT Recertification Form Upload requirements	CPR Card Upload requirements

more items

AEMT-CC Applicant(s) Submission(s)

First Name	Last Name	Expiration Date	EMT Number	DOH-5066 AEMT-CC Recertification Form	CPR Card	ACLS Certification	PALS Certification
First Name	Last Name	Expiration Date	EMT Number	DOH-5066 AEMT-CC Recertification Form Upload requirements	CPR Card Upload requirements	ACLS Certification Upload requirements	PALS Certification Upload requirements

more items

EMT-P Applicant(s) Submission(s)

First Name	Last Name	Expiration Date	EMT Number	DOH-4231 EMT-P Recertification Form	CPR Card	ACLS Certification	PALS Certification
First Name	Last Name	Expiration Date	EMT Number	DOH-4231 EMT-P Recertification Form Upload requirements	CPR Card Upload requirements	ACLS Certification Upload requirements	PALS Certification Upload requirements

more items

Would you like to attach a voucher?

Yes

"CME Recertification: Students who are members of agencies participating in the CME Recertification program and obtain their training through an approved course sponsor, will be eligible for reimbursement of the mandatory core content hours at the CME refresher rate. Course sponsors may NOT seek reimbursement for the practical skill examinations for these students.

Agencies who are submitting vouchers for students enrolled in the CME recertification program may submit their vouchers once the student has been recertified and received their new EMT certification card. Through a Memorandum of Understanding, a course sponsor may charge an agency for providing CME content.

Course sponsors who are submitting vouchers for students enrolled in the CME recertification program and have a memorandum of understanding with the student and/or agency, may submit their voucher once the student has completed the “core” portion of the CME recertification process." (Bureau of EMS, Policy Statement 20-01)

Voucher Section

Vendor ID	Vendor Name	Invoice Number	Invoice Date	Invoice Amount
Vendor ID	Vendor Name	Invoice Number	Invoice Date	Invoice Amount

Voucher Attachment

Upload requirements

Course Sponsor Submission

Submission of a CME Recertification Application on this page means you are a representative of a BEMS recognized Course Sponsorship and you are submitting on behalf of a student who is a member of an agency the Course Sponsor represents.

Course Number

Course End Date

Level of Care for Submission

All certified providers submitted for renewal on this submission must be from the same level of care.

CFR Applicant(s) Submission(s)

First Name	Last Name	Expiration Date	EMT Number	DOH-5295 CFR Recertification Form	CPR Card
First Name	Last Name	Expiration Date	EMT Number	DOH-5295 CFR Recertification Form Upload requirements	CPR Card Upload requirements

more items

EMT-B Applicant(s) Submission(s)

First Name	Last Name	Expiration Date	EMT Number	DOH-5065 EMT-B Recertification Form	CPR Card
First Name	Last Name	Expiration Date	EMT Number	DOH-5065 EMT-B Recertification Form Upload requirements	CPR Card Upload requirements

more items

AEMT Applicant(s) Submission(s)

First Name	Last Name	Expiration Date	EMT Number	DOH-5067 AEMT Recertification Form	CPR Card
First Name	Last Name	Expiration Date	EMT Number	DOH-5067 AEMT Recertification Form Upload requirements	CPR Card Upload requirements

more items

AEMT-CC Applicant(s) Submission(s)

First Name	Last Name	Expiration Date	EMT Number	DOH-5066 AEMT-CC Recertification Form	CPR Card	ACLS Certification	PALS Certification
First Name	Last Name	Expiration Date	EMT Number	DOH-5066 AEMT-CC Recertification Form Upload requirements	CPR Card Upload requirements	ACLS Certification Upload requirements	PALS Certification Upload requirements

more items

EMT-P Applicant(s) Submission(s)

First Name	Last Name	Expiration Date	EMT Number	DOH-4231 EMT-P Recertification Form	CPR Card	ACLS Certification	PALS Certification
First Name	Last Name	Expiration Date	EMT Number	DOH-4231 EMT-P Recertification Form Upload requirements	CPR Card Upload requirements	ACLS Certification Upload requirements	PALS Certification Upload requirements

more items

Would you like to attach a voucher?

Yes

"CME Recertification: Students who are members of agencies participating in the CME Recertification program and obtain their training through an approved course sponsor, will be eligible for reimbursement of the mandatory core content hours at the CME refresher rate.

Course sponsors may NOT seek reimbursement for the practical skill examinations for these students.

Agencies who are submitting vouchers for students enrolled in the CME recertification program may submit their vouchers at the time of application. Vouchers are processed upon recertification of the provider.

Course Sponsors teaching a Core content refresher are eligible for reimbursement of the student upon successful completion of the course. In this case, the Course Sponsor has priority on these funds. The agency may voucher only if the agency is paying the Course Sponsor, or Course Sponsor has sought reimbursement funding for the registered course.

Voucher Section

Vendor ID	Vendor Name	Invoice Number	Invoice Date	Invoice Amount
Vendor ID	Vendor Name	Invoice Number	Invoice Date	Invoice Amount

Voucher Attachment

Upload requirements

Are you attaching a Course Memorandum?

Yes

Course Memorandum

First Name	Last Name	EMT Number
First Name	Last Name	EMT Number

more applicant

Applicant Submission

Submission of a CME Recertification Application on this page means you are the applicant and you are not sponsored by an agency. This means there is no agency code, or Coordinator signature on your application. Submission on this page is not eligible for EMS education reimbursement funds.

Contact Information for Individual Applicant

First Name

Last Name

Phone

Address

City/Town

State/Province

ZIP/Postal Code

EMT Number

Expiration Date of Certification

Level of Care

DOH-5295 CFR Recertification Form

Upload requirements

DOH-5065 EMT Recertification Form

Upload requirements

DOH-5067 AEMT Recertification Form

Upload requirements

DOH-5066 AEMT-CC Recertification Form

Upload requirements

DOH-4231 Paramedic Recertification Form

ACLS Certification

PALS Certification

CPR Card

Department of Health

The AC3253-S and other information can be found on our website at: http://www.health.ny.gov/nysdoh/ems/main.htm. If you have questions regarding submission of vouchers, please contact our Funding Unit at (518) 402-0996.

Submission of a CME Recertification Application on this page means you are, the agency’s CME Coordinator or, you are an individual submitting your own application and the recertification is sponsored by an agency.

Applicant Submission

Submission of a CME Recertification Application on this page means you are the applicant and you are not sponsored by an agency. This means there is no agency code, or Coordinator signature on your application. Submission on this page is not eligible for EMS education reimbursement funds.

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CME Submission Portal

The AC3253-S and other information can be found on our website at: http://www.health.ny.gov/nysdoh/ems/main.htm. If you have questions regarding submission of vouchers, please contact our Funding Unit at (518) 402-0996.

Submission of a CME Recertification Application on this page means you are, the agency’s CME Coordinator or, you are an individual submitting your own application and the recertification is sponsored by an agency.

Submission of a CME Recertification Application on this page means you are a representative of a BEMS recognized Course Sponsorship and you are submitting on behalf of a student who is a member of an agency the Course Sponsor represents.

"CME Recertification: Students who are members of agencies participating in the CME Recertification program and obtain their training through an approved course sponsor, will be eligible for reimbursement of the mandatory core content hours at the CME refresher rate.

Course sponsors may NOT seek reimbursement for the practical skill examinations for these students.

Agencies who are submitting vouchers for students enrolled in the CME recertification program may submit their vouchers at the time of application. Vouchers are processed upon recertification of the provider.

Applicant Submission

Submission of a CME Recertification Application on this page means you are the applicant and you are not sponsored by an agency. This means there is no agency code, or Coordinator signature on your application. Submission on this page is not eligible for EMS education reimbursement funds.

Department of Health

About

Events

Current Issues

Help

Language Assistance

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