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Provider Licensure

License Renewal

If your EMS personnel license expires September 30, 2012 please submit your renewal application as soon as possible. Due to the large number of expected renewal applications and the National Association of State EMS Officials having their yearly meeting in Idaho at the end of September, we recommend getting your applications in now.

Renewal applications are in the grids below. Please email or call the EMS Bureau at EMSProvLic@dhw.idaho.gov or 1-877-554-3367 if you have any questions.

Questions about filling out the new rule renewal form? Watch this webinar for answers!

Provider Licensure Forms

These forms are in PDF format. Click on the form you need, print, complete, and return to the Idaho EMS Bureau. 

Address: PO Box 83720
Boise, ID 83720-0036
Fax: 208-334-4015
Email: EMSPROVLIC@dhw.idaho.gov

License Applications
Miscellaneous Applications Certificate of Eligibility Forms for Medical Director
Initial Application
(use for Initial and Reinstatement)
Reversion Initial Certificate of Eligibility Skills Verification Designee
Reciprocity Application
-Reciprocity Instructions
-License Verification Request form
Shorten License Cycle
 
Certificate of Eligibility Renewal-coming soon Medical Director Change Form
Transition Application Agency Affiliation Status Change form