Emergency Medical Services

EMS Personnel Forms

• Affidavit to Downgrade (PH-4072)
• Affidavit to Retire License (PH-3932)
• EMS Miscellaneous Fees (PH-3940)
• EMS Professional Fees (PH-2397) 1-15-2020
• EMS Licensure/Certification Application (PH-3937)
• Online License application: http://lars.tn.gov
  
• Criminal Background Disclosure (PH-3856)
• Declaration of Citizenship Form (PH-4183A) REV 1-13-2021
• Statement of Licensure Level Form (PH-4291)
• Medical Statement Form (PH-0130)

Education Forms

• Application for Course Approval (PH-2792)
• Exam Cover Sheet (PH-3459)

EMR

• EMR Practical Skills Verification (PH-3677)
• EMR Initial Class Folder Checklist (PH-3855)
• Verification of EMR Refresher Training (PH-3933)

EMT

• EMT Initial Class Folder Check List (PH-3945) 
• EMT Initial Individual Folder Checklist (PH-3944) Rev. 12-11-19
• EMT Skills Evaluation (PH-3786) Rev 12-16-2020
• Verification of Initial Clinical Training (PH-3787)
• EMS Clinical Assessment for EMT Trainees (PH-3785)
• Verification of Education (PH-2388)

AEMT

• EMS Clinical Assessment for AEMT Trainees (PH-3785)
• AEMT Skills Evaluation (PH-3805) Rev 12-16-2020
• AEMT Class Folder Checklist (PH-3858)
• AEMT Class Individual Folder Checklist (PH-4241) Rev. 12-11-19

Paramedic

• Paramedic Class Folder Checklist (PH-3857)
• Paramedic Skills Evaluation (PH-3806) Rev 1-6-2021
• Paramedic Class Individual Folder Checklist (PH-4240) Rev. 12-11-19

Paramedic - Critical Care

• Verification of Paramedic-Critical Care Training (PH-4239)
• Paramedic-Critical Care Class Folder Checklist (PH-4245) Rev 11-20-19