EMS Provider

First Name

Last Name

EMT Number

EMT Level of Care

- Select -AEMT - ParamedicAEMT - Critical CareAEMTEmergency Medical TechnicianCertified First ResponderNot Currently Certified

EMS Provider Telephone Number

EMS Provider Email Address

EMS Provider Email Address

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EMS Agency

EMS Agency Name

If you are not affiliated with an EMS agency, please enter N/A.

EMS Agency Highest Level of Care

- Select -AEMT - ParamedicAEMT - Critical CareAEMTBasic Life SupportNot Affiliated

If you are not affiliated with an EMS Agency, please click on "Not Affiliated"

Categories and Question

Operational Questions ~ EMS Agency Leadership

- None -Agency Certification Agency OperationsCME ProgramET3 (Alternate Destinations)ET3 (Telemedicine)ET3 (Treat in Place)DeploymentsFirst ResponsePolicy StatementsProvider Covid-19 TestingPPEQuarantinesOther

Operational Question for Discussion

Education Questions ~ Course Sponsors

- None -Classes in ProgressComputer Based TestingPractical Skills ExamsWritten Exams

Educational Question for Discussion

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