TITLE 12. HEALTH
REGISTRAR'S NOTICE:
Forms used in administering the following regulation have been filed by the
Department of Health. The form is not being published; however, online users of
this issue of the Virginia Register of Regulations may click on the name of a
form to access it. The form is also available from the agency contact or may be
viewed at the Office of the Registrar of Regulations, General Assembly
Building, 2nd Floor, Richmond, Virginia 23219.
Title of Regulation: 12VAC5-31. Virginia Emergency
Medical Services Regulations.
Contact Information: Michael D. Berg, Manager,
Regulation and Compliance, Department of Health, 1041 Technology Park Drive,
Glen Allen, VA 23059-4500, email michael.berg@vdh.virginia.gov.
FORMS (12VAC5-31)
EMT Clinical Training Summary Record, EMS.TR.05
(rev. 8/2012)
Training Program Complaint Form, EMS.TR.30 (rev.
1/2011)
Course Approval Request, EMS.TR.01 (rev. 6/2011)
Course
Approval Request, EMS.TR.01 (rev. 4/2016)
CTS Payment Request Form, EMS.TR.CTS.001 (rev.
6/2012)
EMS Variance/Exemption Application for Providers,
EMS 6036 (rev. 6/2011)
EMS Variance/Exemption Application for Agencies,
EMS 6037 (rev. 6/2011)
Course Summary Form, EMS.TR.03 (rev. 6/2011)
EMS Certification Application, Form A (undated)
EMS Training Program Enrollment Form, Form E
(undated)
EMS Continuing Education Registration Card
(undated)
Application for EMS Agency License (rev. 8/2012)
Application for EMS Vehicle Permit and
Instructions (rev. 8/2012)
Complaint Report Form (rev. 11/2010)
Operational Medical Director Agreement (rev.
8/2012)
ALS-Coordinator Application, EMS.TR.31 (rev.
11/2011)
Emergency Medical Services Medical Record (rev.
6/2010)
BLS Course Student Information Package, EMS.TR.09
(rev. 5/2012)
ALS Course Student Information Package, EMS.TR.10
(rev. 5/2012)
BLS Individual Age, Clinical and Skill Performance
Verification, EMS.TR.33 (rev. 1/2011)
Student Permission Form for BLS Students Less than
18 Years Old, EMS.TR.07 (rev. 7/2011)
Physician Assistant & Nurse Practitioner Paramedic
Challenge Competency Summary, EMS.TR.37 (rev. 2/2012)
Program Accreditation Application, Instructions
and Self Study - Paramedic (rev, 7/2012)
Program Accreditation Application, Instructions
and Self Study - Intermediate (rev. 7/2012)
Alternative Site Application for EMS Programs in
Virginia (rev. 7/2012)
Rescue Squad Assistance Fund Grant Application, Office of
Emergency Services (http://www.vdh.virginia.gov/OEMS/Agency/Grants/index.htm)
EMS System Initiative Award Application, Office of Emergency
Services (http://www.vdh.virginia.gov/OEMS/Agency/Grants/index.htm)
OEMS Grant Program Memorandum of Agreement (rev.
1/2012)
VA.R. Doc. No. R16-4684; Filed April 26, 2016, 3:25 p.m.