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State of Alaska

DHSS State of Alaska

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Forms & Publications

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Emergency Medical Services Unit
Forms and Applications

Link to Certification Database

For additional information on Alaska EMS Certification email ems.certification@alaska.gov or call 907-465-3029.

Forms for Individuals:

Course Forms

Certification Forms

Initial Certification (01/14)
Recertification (10/10)
Venipuncture Form for Certification as an EMT-II (02/05)
Application for Reciprocity Certification (01/14)
Emergency Medical Dispatcher Initial (10/09)
Emergency Medical Dispatcher Recertification (10/09)
Extension Request (01/12)
Certifying Officer Application (01/14)

Course Prerequisites

Proof of Patient Contacts EMT-II Candidates (10/02)
Proof of Patient Contacts EMT-III Candidates (10/02)
Patient Contact Form for EMT-II Candidates (9/05)
Patient Contact Form for EMT-III Candidates (01/14)
Medical Director Verification for EMT-II Candidates (08/02)
Medical Director Verification for EMT-III Candidates (08/02)
Venipuncture Form for entry into EMT-III Training Programs (12/05)

Instructor Certification Forms

ETT Instructor Initial (10/09)
ETT Instructor Recertification (10/09)
EMT-I Instructor Initial (01/14)
EMT-II/III Instructor Initial (01/14)
EMT-I Instructor Recertification (10/09)
EMT-II/III Instructor Recertification (01/14)
Medevac Escort Instructor Initial (9/07)
Reauthorization for Air Medical Escort Instructor (9/08)
MICP Course Coordinator Initial (10/09)
MICP Course Coordinator Recertification (10/09)

Frequently Asked Questions about Certification

Forms for Services

Basic and Advanced Life Support Ground EMS Unit Application (01/14)
Medevac Air Medical Service Application (8/05)
Critical Care Air Ambulance Service Application (8/05)
Specialty Air Medical Transport Team Application (7/05)

PCR

State of Alaska Model Pre-hospital Patient Report Form (5/99)

Mandatory Reporting

Expanded Scope

Read more about Expanded Scope of Practice: Adding Additional Medications or Procedures for EMTs.

Application for Expanded Scope (7/05)
Expanded Scope Renewal Application (7/05)