To apply for ambulance licensure an applicant service must complete and

To apply for ambulance licensure an applicant service must complete and submit the following: 1. Application for Ambulance Service Licensure; 2. Roster of all proposed employees, including Emergency Vehicle Operators (EMS-Driver), EMTs, AEMTs, Paramedics, Critical Care Paramedics, RNs and Emergency Medical Dispatchers, and others if appropriate (this list must include state-issued certification and/or license numbers where applicable); 3. The proposed medical control plan, including protocols (at least 30 days prior to intended service start date); 4. Patient destination guidelines which comply with all state approved system of care plans and standards; 5. Documentation describing communications capabilities, including capability to communicate with dispatch and primary resource hospital; 6. Documentation describing the methods to be used for communicating with on-line medical control, conducting quality assurance and ensuring skill maintenance; 7. Letter of attestation from the off-line medical director approving of the proposed medical control plan, approving of the proposed the ambulance provider’s protocols, and acknowledging he/she understands his/her responsibilities as prescribed in this document (Title 15, Part 12, Subpart 31); and 8. Letter of attestation from the ambulance owner acknowledging intent to provide 24/7 coverage, providing evidence of capabilities, describing staffing patterns, providing plans for backup, and listing mutual aid agreements.