Provider Licensure Forms

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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 -License Verification Request form	Shorten License Cycle	Renewal Certificate of Eligibility-coming soon	Medical Director Change Form
Transition Application	Agency Affiliation Status Change form

If you were licensed...	Renewal Application with Guide	Continuing Education Tracker Tool	Continuing Education Tracking for Transition Education	Standards Manuals	Rule
prior to 3/30/2009 you fall under this rule.	EMR Renewal Guide EMT Renewal Guide AEMT Renewal Guide Paramedic Renewal Guide	N/A	N/A	Standards manual 9/1/2006 to 3/30/2009	Rule 16.02.03
between 3/31/2009 and 3/31/2011 you fall under this standards manual and rule.	Use renewal guides above	N/A	N/A	Standards manual 3/31/2009 to 3/31/2011	Rule 16.02.03
between 4/1/2011 and 6/30/2011 you fall under this standards manual and rule.	Use renewal guides above	N/A	N/A	Standards manual 4/1/2011 to 6/30/2011	Rule 16.02.03
If you were licensed at any time, you may choose to renew under this new rule. 7/1/2011 or later you fall under this new rule.	New rule-EMR Renewal Guide New rule-EMT Renewal Guide New rule-AEMT Renewal Guide New rule-Paramedic Renewal Guide	EMR CE Tracker EMT CE Tracker AEMT CE Tracker Paramedic CE Tracker	EMR Transition course CE hours verification EMT Transition course CE hours verification AEMT Transition course CE hours verification Paramedic Transition course CE hours verification	There is no longer a Provider Licensure Standards Manual as information is integrated into rule	Rule 16.01.07

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