EMS: Required State Forms
The forms listed on this page relate to Wisconsin EMS (Emergency Medical Services). Select a link to view, print, and use the file as needed. We regularly review and update the forms.
License application forms
- E-Licensing—Apply for a license online. All license applications now use one form in E-Licensing instead of each having their own form.
- Affidavit of No Social Security Number—EMS Professional License, F-00893 (Word)—Use this form if you don’t have a Social Security number but wish to apply for an EMS license or certificate. Either this form or a Social Security number is required to apply.
Service credential forms
- EMS Service Director License Proxy for Individuals, F-00114—Complete this form (EMS service providers only) if you have people who can’t access the E-Licensing system. This form authorizes the service director to act on behalf of the people listed to process initial and renewal license applications.
- EMS Training Center Training Permit Eligibility Certification, F-00646 (Word)—Complete this form to get an Emergency Medical Technician Training Center Training Permit.
- Patient Side Training Report, F-00703 (PDF)—Complete this form if your ambulance service transported a medicine that does not appear on the Wisconsin Paramedic Curriculum Based Medication List (PDF) or in the service’s approved Provider Operational Plan.
- Physician, Physician Assistant, and Registered Nurse Equivalency Application, F-00614 (Word)—Complete this form to act as part of a legal ambulance crew.
Other forms and applications
- Change of EMS Medical Director, F-47470—Complete this form if there’s a new EMS medical director.
- Document Sales & Distribution Ordering Site—Order the form WKC 8165 Determination of Exposure to Blood/Body Fluids (in quantities of 25). Search for SKU number SBD10781.
- EMS Complaints and Investigation—Learn how to file a complaint against EMS.
- EMS E-Licensing Service Demographic Information, F-02570 (PDF)—Complete this form to make staff changes to an EMS service provider.
- EMS Patient Care Worksheet, F-47489 (PDF)—Use this form if you’re an ambulance service provider. It provides patient care information to the receiving facility.
- EMS Provider Operational Plan—Learn about operational plan requirements in Wisconsin.
- Request for Waiver of Administrative Rule for Licensure, F-00569 (Word)—Use this form to waive a license requirement that isn’t required by law.
Glossary
Go to E-Licensing Portal
Log into your E-Licensing account for Wisconsin
