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Controlled Substance Submissions
Welcome to the New York State Department of Health Bureau of Emergency Medical Service Controlled Substances renewal portal.
All renewal applications are due no less than 30 days prior to the expiration date of the agency’s operating certificate. Ensure that all of the required documents are completed and uploaded in the appropriate section.
Please make sure that all corporate officers, including volunteer officers, Home addresses and telephone numbers are included.
Should you have any questions please feel free to contact your Regional Representative:
https://www.health.ny.gov/professionals/ems/chart.htm
Is this an initial application or a renewal?
Initial Application
Renewal Application
NYS DOH EMS Region
- Select -
Central NY (Syracuse Regional Office)
Capital (Central Office)
Metropolitan (MARO)
Western Region(Buffalo and Rochester Regional Office)
Name of Service
Agency Code
Name of Contact Person
Full Name
Email
Phone
Level of Care
- Select -
AEMT-CC
Paramedic
DOH-3826 Application for ALS Agency to Engage in Controlled Substances Activity for Prehospital Care.
Upload
Upload requirements
One file only.
100 MB limit.
Allowed types:
txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods
.
Copy of Operating Certificate
Upload
Upload requirements
One file only.
100 MB limit.
Allowed types:
txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods
.
Copy of the $100.00 payment mailed to the Regional DOH office
Upload
Upload requirements
One file only.
100 MB limit.
Allowed types:
txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods
.
If any of the following below have changed, please complete the forms below
DOH-3827 Application to be a Controlled Substance Agent for an ALS Agency
Upload
Upload requirements
One file only.
100 MB limit.
Allowed types:
txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods
.
DOH-4362 Medical Director Verification
Upload
Upload requirements
One file only.
100 MB limit.
Allowed types:
txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods
.
DOH-2828 EMS Agency Personnel Roster
Upload
Include only employees/members who are authorized to administer controlled.
Upload requirements
One file only.
100 MB limit.
Allowed types:
txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods
.
Copy of Current Controlled Substances License
Upload
Upload requirements
One file only.
100 MB limit.
Allowed types:
txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods
.
Current Controlled Substances Operations Plan
Upload
Upload requirements
One file only.
100 MB limit.
Allowed types:
txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods
.
DOH-3848 Controlled Substance Report for Emergency Medical Services Agencies
Upload
This is for the duration of the current license.
Upload requirements
One file only.
100 MB limit.
Allowed types:
txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods
.
Supplier Agreement
Upload
Upload requirements
One file only.
100 MB limit.
Allowed types:
txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods
.
Submit
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