836 IAC 2-2-2 Application for certification; renewal

Sec. 2. (a) Application for certification as a paramedic provider organization shall be made on forms provided by the agency and shall comply with the following: (1) Applicants shall complete the required forms and submit the forms to the agency not less than sixty (60) days prior to the requested effective date of the certificate. (2) Each application shall include a narrative summary of plans for providing advanced life support services, including the following: (A) Defined primary area of response, including location of advanced life support response vehicles. (B) A roster of all affiliated personnel, signed by the medical director and the chief executive officer, including certification numbers. (C) The staffing pattern of personnel. (D) Base of operations. (E) Organizational structure, including name, address, and phone numbers for the: (i) owner; (ii) chief executive officer; (iii) chief operations officer; (iv) training officer; and (v) medical director. (F) Location of paramedic provider organizations records. (G) Proof of insurance coverage for emergency medical service vehicles if required by 836 IAC 1-3-6. (H) Plans and methodologies to ensure that the trained personnel are provided with supervised continuing education to maintain proficiency. Continuing education is under the direct supervision of the paramedic provider organization medical director with the cooperation of the supervising hospital. (I) A listing of medications and special onboard life support equipment to be carried on board each vehicle as approved by the medical director. (J) All scheduled medications shall be stored in a locked container within a locked compartment. Medications storage shall be approved in writing by medical director or issuing pharmacy. (K) Letter of approval from the supervising hospital stating: (i) acceptance of the paramedics; (ii) compatibility of the UHF communications with the paramedic provider organization's vehicles; and (iii) agreement to fulfill the responsibilities of the supervising hospital. (L) Copy of agreement or interdpartmental [sic, interdepartmental] memo as required in section 1(d) of this rule. (M) Other information as required by the agency. (b) Paramedic provider organizations that do not also provide transportation of emergency patients shall submit and maintain a copy of a current agreement between the nontransporting paramedic provider organization and an ambulance service provider organization certified under IC 16-31. The agreement shall: (1) ensure that the nontransporting paramedic provider organization can be assured that patients treated shall be transported in a timely and safe manner; and (2) not preclude another ambulance service provider organization, if available, from transporting the patients. (c) Upon approval, a paramedic provider organization shall be issued certification for the provision of advanced life support. (d) The certificate: (1) expires on the date appearing in the expiration date section of the certificate; and (2) shall be prominently displayed at the place of business. (e) Application for paramedic provider organization certification renewal should be made not less than sixty (60) days prior to the expiration date of the current certification. Application for renewal shall: (1) be made on forms provided by the agency; and shall [sic] (2) show evidence of compliance with the requirements as set forth for original certification.