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Louisiana Department of Health & Hospitals | Kathy Kliebert, Secretary

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Statewide Initiatives



211 - Get Connected. Get Answers.

Emergency Medical Services Applications & Forms

Licensure Forms

EMS License Renewal Application - Complete this application in order to recertify your state of Louisiana EMT card.

Initial License Form - Use this form if this is your first time applying for an EMS Professional License (EMR, EMT, AEMT, Paramedic) and you completed your training in Louisiana.

If your state EMT certification has lapsed as of March 31, you must complete a Reinstatement Application.

RECIPROCITY

Reciprocity Form - This application must be completed if EMT training and/or testing was completed out of the State of Louisiana in order to transfer EMT certification from another state.

STUDENT SECTION

EMSCC Disclosure Form - All students must complete this form to be sent in with Initial Course Roster.

Examination Form - In order to register for the National Registry exam, please complete this form completely. Incomplete forms will be returned.

Certification Form - You must complete this form in order to practice as an EMT in the State of Louisiana.

OTHER FORMS

Duplicate EMT Card - The Bureau of EMS requires this form in order to get a duplicate EMT card.

Rural AED Program Application - This Rural Access to Emergency Devices application must be completed by every organization applying for an AED. You must submit a separate application for each AED requested.

AED Notification & Summary Form - This form is to be completed by all entities in possession of an Automated External Defibrillator (AED) and submitted to the Bureau of EMS and your local EMS/Fire Dept. in order to comply with RS40:1236.13.

Other Resources