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Louisiana Department of Health & Hospitals | Kathy Kliebert, Secretary

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Statewide Initiatives



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Emergency Medical Services Applications & Forms

On-Line License Verification

On-Line Verification - Verify the status of an EMS License.  Search by last name or license number.

Licensure Forms

EMS License Renewal Application - Complete this application in order to recertify your state of Louisiana EMT card.

Initial License Form - Use this form if this is your first time applying for an EMS Professional License (EMR, EMT, AEMT, Paramedic) and you completed your training in Louisiana.

RECIPROCITY

Reciprocity Form - This application must be completed if EMT training and/or testing was completed out of the State of Louisiana in order to transfer EMT certification from another state.

STUDENT SECTION

Student Application Form - EMS students enrolling in a Bureau of EMS approved EMS course must complete this application and return it to the course instructor.

EMSCC Disclosure Form - EMS students with a potential disqualifying background clearance event must complete this MOU when enrolling in an EMS course.

EMSCC Disclosure Form - EMS students with a potential disqualifying background clearance event must complete this full disclosure and personal statement when enrolling in an EMS course. Students with a potential disqualifying event must receive clearance from the Bureau of EMS prior to starting clinicals or a field internship program.

Examination Form - In order to register for the National Registry exam, please complete this form completely. Incomplete forms will be returned.

Initial License Form - Use this form if this is your first time applying for an EMS Professional License (EMR, EMT, AEMT, Paramedic) and you completed your training in Louisiana.

NREMT Exam Sheets (EMT) - Effective April 1, 2014, the Louisiana Bureau of EMS will use the NREMT EMT Skills Forms for psychomotor examinations in Louisiana.  (EMS Instructors may request the Bureau of EMS to test specific students on the prior forms until June 2015.)

OTHER FORMS

Duplicate EMT Card - The Bureau of EMS requires this form in order to get a duplicate EMT card.

Rural AED Program Application - This Rural Access to Emergency Devices application must be completed by every organization applying for an AED. You must submit a separate application for each AED requested.

AED Notification & Summary Form - This form is to be completed by all entities in possession of an Automated External Defibrillator (AED) and submitted to the Bureau of EMS and your local EMS/Fire Dept. in order to comply with RS40:1236.13.

Other Resources