Planning and Operations 1. Standing Items a. KEMSIS Update No new information at this time

Size: px
Start display at page:

Download "Planning and Operations 1. Standing Items a. KEMSIS Update No new information at this time"

Transcription

1 KBEMS Committee Meetings October 2, 2014 Planning and Operations a. KEMSIS Update No new information at this time 2. Old Business a Hearing is scheduled for Oct 16, 2014 in Rm 560 See board packet for Proposed Spinal Motion restriction guidelines need to be considered with these requirements to make this equipment optional. This will be returned to the next board meeting. b became Law August 29, 2014 (Medication List) Med list is posted on the website c. Outstanding service sticker for outstanding inspections. Criteria is no errors during inspection process. This will start next year. Discussion of concern for sticker that identifies someone as an outstanding service without identifying inspection on the sticker add inspection. What about things that are repaired at the time (i.e. lights)? Initial discussion was a perfect inspection. Discussion on odds of having a perfect inspection changes for the service with 3 trucks vs the service with 28 trucks. Some things that are on the list are not in violation of state law for vehicles. Either committee needs to finalize details or a discussion for the full board. 3. New Business a. SCT Discussion Definition of SCT in the regulations is similar to Medicare definition. Services can bill SCT. 4. Presentation by KDHE Rural Health Survey. Packet given out EMS service director leadership training survey done June of 171 responded to this survey. Survey results are in this packet. Communication, Networks, Team Building were the top three interests for Leadership and Management training. 5. One confirmed case of Ebola, CDC has put out transport guidelines take time to review these and be aware of this. 6. Public Comment 7. Member Comments Reminder: These are NOT the official minutes and are provided courtesy of Region III for informational purposes only. For the official minutes, see the Kansas Board of EMS website

2 Executive Committee a. Legislative Update Development of 2015 Session Legislative Packet (to be discussed in New Business) b. MAC Report September Teleconference Meeting Notes The agenda focused on the position statements for RSI and Helicopter EMS Utilization, the MAC portion of the KBEMS website, Kansas Continued Competency, establishing 2015 meeting dates, and a participation request for membership on the FLEX EMS committee. Also discussed peer review legislative issues and Community Paramedicine as it move forward. 2. Old Business a. AG Opinion EMS attendant capabilities / limitations outside EMS environment. Received a letter acknowledging receipt, but no new information or anticipated date of response. b. State EMS Director no new information No discussion c. Board Bylaws A draft version of the board bylaws/guidelines is available for consideration/comments. This version reflects all compiled comments received from Board members since the August meeting. Next step is to review with comments and make a final draft. d. REPLICA The final draft version of the legislative has been provided. Board staff recommendation is to pursue this as a legislative priority in the 2015 Legislative Session 3. New Business a. Legislative packet for 2015 Staff is recommending that the Board pursue similar legislation as the 2014 session with the emphasis on clean up language, unifying process, and authority to implement a civil fine in lieu of other means of disciplinary action. Review scope for all levels to make sure it is not too specific with devices. Much discussion regarding subpoena powers 4. Public Comment Public comment time on the agenda is limited to no more than 5 minutes by any one speaker. If an individual wishes to comment on an agenda item after committee discussion but before a vote, one should notify the Chair prior to the start of the meeting.

3 5. Adjournment EETC Committee a. Transition Update 668 attendants remain to transition at the time of the agenda being released. Some have transitioned since this was released. Expire 2014 Expire FR 1 Fr 84 EMT B 96 EMT B 204 EMT I 186 EMT I 6 EMT D 6 EMT D 39 EMT I/D 42 EMT I/D Discussion followed regarding those that have not completed transition and if they are engaged and aware of the need to complete a transition course. 2. Regulations The following regulations are in the state process: , e, , a, a, a, and The following are open for revision: , , , , and Variances No variances have been submitted 4. BLS Exam Vendor Report Brad Sisk Discussion on new scenarios and need for new check sheets 5. EDTF a. Kansas Continued Competency see supporting document on board website action item. Request board action for approval of hours requirement for EMT to 34 hours. No action at this time Motion to take KCC forward but leave EMT hours open at this time. Second and passed. b. Scenario Development Ongoing c. Educator Proposal Implementation Plan Ongoing

4 In process of form development, working to make sure these coordinate in form and substance with current forms. Reviewing mentor process 6. Old Business a Long term accreditation of training programs conducting initial courses of instruction currently in revocation process b. AEMT Education Standards see supporting document (medication list) on board website Action Item Motion to move this forward to full board. 7. New Business Committee Purpose in reference to the by laws being drafted 8. Announcements Education Manager Report Naloxone from the NREMT perspective no additional information Information from the Kansas Athletic Trainers on possible removal of sports protective equipment. Committee received a position statement from NATA. Contact local EMS providers this is about communication with the local teams EMS is doing stand bys for on Friday nights. Audit of two AEMT transition courses Discussion on the TO renewal form regarding requiring documentation of 20 hours of instruction time this has been in regulation but has never been requested to submit proof of this. Copies of rosters will suffice as proof of education. 9. Public Comment Investigations Consent Agenda Continuing education edit recommend audit the next two report cycles of 2014 and 2016 pulled from consent agenda for discussion. Motion to follow recommendation of two cycles of audit. Second and passed Felony conviction withdrew application Felony conviction withdrew application

5 Felony conviction withdrew application Felony conviction withdrew application Felony conviction withdrew application Consent agenda 2 6 have motion to approve as listed. Motion second and passed. Other Cases self report of unauthorized activities alleging EMT initiated IV, AEMT allowed it then falsified the report by documenting AEMT started the IV. AEMT no longer working for service, currently attending a paramedic program self report of unauthorized activity (see above) EMT suspended for 24 hours and required to do a presentation to the service on working outside authorized activities. Attendant is no longer full time, but does work some part time. 37 and 38 discussed together EMT received local action in suspension and presentation, AEMT did not receive local action. AEMT Motion to produce a summary proceeding order for 3 month suspension, to serve 1 month suspension with the remaining 2 months stayed pending no further occurrences in the following 2 years. This will cover both issues. Motion second. Question on how this affects paramedic internship riding as a 3 rd person/student this would fall to the institution. Motion Passed. EMT Motion to produce a summary proceeding order for 2 month suspension, to be stayed pending no further occurrences in the following 1 year. Motion passed Discussion to allow board staff to close cases for felony applications with withdraw of application without going to investigations. Sensitive material request everyone leave the room

Planning and Operations Standing Items 1. KEMSIS Report from Chad Pore on 4 services that have gone live on new Image Trend software

Planning and Operations Standing Items 1. KEMSIS Report from Chad Pore on 4 services that have gone live on new Image Trend software KSBEMS Meetings February 2016 Disclaimer: This summary is provided courtesy of Region III EMS Council. All efforts have been made to accurately report on the committee and Board meetings. However, these

More information

b. Sample Protocol Whitlock Not yet completed no update or information

b. Sample Protocol Whitlock Not yet completed no update or information Kansas Board of EMS Subcommittee Meetings December, 2013 Summary notes only. These are NOT the official minutes of the meetings. Reminder: These are NOT the official minutes and are provided courtesy of

More information

Staff & Training. Contra Costa County EMS Agency. Table of Contents EMT Certification Paramedic Accreditation

Staff & Training. Contra Costa County EMS Agency. Table of Contents EMT Certification Paramedic Accreditation Contra Costa County EMS Agency Staff & Training Table of Contents 2000 Administrative Policy Number Formally EMT Certification 2001 1 Paramedic Accreditation 2002 2 MICN Authorization / Reauthorization

More information

Please Note: Please send all documentation related to the credentialing portion of this documentation to:

Please Note: Please send all documentation related to the credentialing portion of this documentation to: Please ote: The application process is split into different actions. Please send all documentation related to the contracting portion of this documentation to: Fax to: (916)350-8860 Or email to: BSCproviderinfo@blueshieldca.com

More information

CHAPTER ONE RULES PERTAINING TO EMS AND EMR EDUCATION, EMS CERTIFICATION, AND EMR REGISTRATION

CHAPTER ONE RULES PERTAINING TO EMS AND EMR EDUCATION, EMS CERTIFICATION, AND EMR REGISTRATION CodeofCol or adoregul at i ons Sec r et ar yofst at e St at eofcol or ado DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT EMERGENCY MEDICAL SERVICES 6 CCR 1015-3 [Editor s Notes follow the text of the rules

More information

NORTHERN CALIFORNIA EMS, INC. 930 Executive Way, Suite 150, Redding, CA Phone: (530) Fax: (530)

NORTHERN CALIFORNIA EMS, INC. 930 Executive Way, Suite 150, Redding, CA Phone: (530) Fax: (530) NORTHERN CALIFORNIA EMS, INC. 930 Executive Way, Suite 150, Redding, CA 96002-0635 Phone: (530) 229-3979 Fax: (530) 229-3984 EMT Application Check One: INITIAL CERTIFICATION RENEWAL CERTIFICATION Please

More information

Professional Credential Services, Inc.

Professional Credential Services, Inc. Professional Credential Services, Inc. P.O. Box 198689 - Nashville, TN 37219-8689 www.pcshq.com Licensure Application for Athletic Trainers For the Massachusetts Board of Allied Health Professionals If

More information

COUNTY OF SACRAMENTO EMERGENCY MEDICAL SERVICES AGENCY

COUNTY OF SACRAMENTO EMERGENCY MEDICAL SERVICES AGENCY COUNTY OF SACRAMENTO EMERGENCY MEDICAL SERVICES AGENCY Document # 4520.10 PROGRAM DOCUMENT: Draft Date: 12/08/95 Paramedic Training Program Effective: 05/01/16 Revised: 09/28/15 Review: 11/01/17 EMS Medical

More information

Joseph J. Bova, RPh. This program has been brought to you by PharmCon

Joseph J. Bova, RPh. This program has been brought to you by PharmCon Joseph J. Bova, RPh This program has been brought to you by PharmCon PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education Speaker: Joseph

More information

TEXAS MEDICAL BOARD LICENSURE COMMITTEE MEETING MINUTES April 7-8, 2010

TEXAS MEDICAL BOARD LICENSURE COMMITTEE MEETING MINUTES April 7-8, 2010 TEXAS MEDICAL BOARD LICENSURE COMMITTEE MEETING MINUTES April 7-8, 2010 The meeting was called to order at 3:30 pm on April 7, 2010 by Chair, Michael Arambula, M.D. Committee members present were Jose

More information

OREGON HEALTH AUTHORITY, OFFICE OF EQUITY AND INCLUSION DIVISION 2 HEALTH CARE INTERPRETER PROGRAM

OREGON HEALTH AUTHORITY, OFFICE OF EQUITY AND INCLUSION DIVISION 2 HEALTH CARE INTERPRETER PROGRAM OREGON HEALTH AUTHORITY, OFFICE OF EQUITY AND INCLUSION DIVISION 2 HEALTH CARE INTERPRETER PROGRAM 333-002-0000 Purpose (1) These rules establish the Health Care Interpreter program, a central registry,

More information

FLORIDA ~ STATUTE , and Florida Statutes

FLORIDA ~ STATUTE , and Florida Statutes FLORIDA ~ STATUTE STATUTE DATE Enacted 1976 REGULATORY BODY PA DEFINED SCOPE OF PRACTICE PRESCRIBING/DISPENSING SUPERVISION DEFINED 458.347, 458.348 and 627.419 Florida Statutes Council on Physician Assistants;

More information

County of San Luis Obispo Emergency Medical Services Agency

County of San Luis Obispo Emergency Medical Services Agency County of San Luis Obispo Emergency Medical Services Agency 2180 Johnson Ave, 2 nd Floor, San Luis Obispo, CA 93401 Phone: 805.788.2511 Fax: 805.788.2517 www.sloesma.org Dear EMT Applicant: Initial certification

More information

Name of Sex: M F Applicant: Last First Middle. Date of Birth: Social Security Number: Phone: ( ) City State Zip. Phone: ( ) City State Zip

Name of Sex: M F Applicant: Last First Middle. Date of Birth: Social Security Number: Phone: ( ) City State Zip. Phone: ( ) City State Zip SCHNEIDER REGIONAL MEDICAL CENTER 9048 SUGAR ESTATE ST. THOMAS, U.S.V.I 00802 APPLICATION FOR TEMPORARY PRIVILEGES (USED FOR URGENT PATIENT NEED AND LOCUM TENENS) COMPLETE THE APPLICATION IN FULL. PRINT

More information

Guidelines for Authorized Emergency Medical Services Continuing Education Providers

Guidelines for Authorized Emergency Medical Services Continuing Education Providers Guidelines for Authorized Emergency Medical Services Continuing Education Providers July 1, 2009 County of San Diego Health & Human Services Agency Emergency Medical Services Branch 6255 Mission Gorge

More information

Department: Legal Department. Approved by:

Department: Legal Department. Approved by: HAWAII HEALTH SYSTEMS C O R P O R A T I O N Touching Lives Everyday" Policies and Procedures Subject: Credentialing Requirements Department: Legal Department Issued by: Rene McWade, Esq. VP & General Counsel

More information

(January 2017) Published by: CAL FIRE EMS Program 4501 State Highway 104 Ione, CA

(January 2017) Published by: CAL FIRE EMS Program 4501 State Highway 104 Ione, CA EMERGENCY MEDICAL TECHNICIAN INITIAL AND RE-CERTIFICATION APPLICATION PACKET (January 2017) Published by: CAL FIRE EMS Program 4501 State Highway 104 Ione, CA 95640-9705 DEPARTMENT OF FORESTRY AND FIRE

More information

10111 Richmond Avenue, Suite 400, Houston, Texas (713) / (866) (Toll Free) / (713) (Fax)

10111 Richmond Avenue, Suite 400, Houston, Texas (713) / (866) (Toll Free) / (713) (Fax) Application Date: \ \ Date Available: \ \ Provider s Name: O MD O DO O PA O NP SS # : City: State: Zip: Home Phone ( ) Work Phone ( ) Pager ( ) Cell Phone ( ) E-Mail address: Driver s Lic. # Expires: \

More information

PHILADELPHIA FIRE DEPARTMENT DIRECTIVE #61 OCTOBER 2015 SUBJECT: EMERGENCY MEDICAL SERVICE CERTIFICATIONS

PHILADELPHIA FIRE DEPARTMENT DIRECTIVE #61 OCTOBER 2015 SUBJECT: EMERGENCY MEDICAL SERVICE CERTIFICATIONS PHILADELPHIA FIRE DEPARTMENT DIRECTIVE #61 SUBJECT: EMERGENCY MEDICAL SERVICE CERTIFICATIONS 1. POLICY 1.1 It is the policy of the Philadelphia Fire Department that all uniform members possess and maintain

More information

VNSNY CHOICE PRACTITIONER CREDENTIALING APPLICATION

VNSNY CHOICE PRACTITIONER CREDENTIALING APPLICATION Attached please find an application for participation with VNSNY CHOICE. Upon completion, please forward this application to: VNSNY CHOICE Attn: Provider Relations Network Development 1250 Broadway - 11th

More information

STATEMENT OF BASIS AND PURPOSE, REGULATORY ANALYSIS AND SPECIFIC STATUTORY AUTHORITY

STATEMENT OF BASIS AND PURPOSE, REGULATORY ANALYSIS AND SPECIFIC STATUTORY AUTHORITY DEPARTMENT OF HUMAN SERVICES Alcohol and Drug Abuse Division ADDICTION COUNSELOR CERTIFICATION AND LICENSURE 6 CCR 1008-3 [Editor s Notes follow the text of the rules at the end of this CCR Document.]

More information

EMS PROVIDER SYSTEM ENTRY PACKET

EMS PROVIDER SYSTEM ENTRY PACKET Emergency Medical Services EMS PROVIDER SYSTEM ENTRY PACKET Directions to all applicants: PLEASE FILL OUT IN ENTIRETY AND SIGN THE FOLLOWING: SYSTEM ENTRANCE APPLICATION AUTHORIZATION AND RELEASE MEMORANDUM

More information

EFFECTIVE DATE: 10/04. SUBJECT: Primary Care Nurse Practitioners SECTION: CREDENTIALING POLICY NUMBER: CR-31

EFFECTIVE DATE: 10/04. SUBJECT: Primary Care Nurse Practitioners SECTION: CREDENTIALING POLICY NUMBER: CR-31 SUBJECT: Primary Care Nurse Practitioners SECTION: CREDENTIALING POLICY NUMBER: CR-31 EFFECTIVE DATE: 10/04 Applies to all products administered by the plan except when changed by contract Policy Statement:

More information

MONTGOMERY COUNTY OFFICE OF EMS Medical Advisory Committee Minutes Meeting Date: November 18, 2015 Start: 9:30a.m. End: 11:30 a.m.

MONTGOMERY COUNTY OFFICE OF EMS Medical Advisory Committee Minutes Meeting Date: November 18, 2015 Start: 9:30a.m. End: 11:30 a.m. MONTGOMERY COUNTY OFFICE OF EMS Medical Advisory Committee Minutes Meeting Date: November 18, 2015 Start: 9:30a.m. End: 11:30 a.m. estimate Location: Public Safety Training Campus 1175 Conshohocken Rd.

More information

Sierra Sacramento Valley EMS Agency Program Policy. Paramedic Training Program Approval/Requirements

Sierra Sacramento Valley EMS Agency Program Policy. Paramedic Training Program Approval/Requirements Sierra Sacramento Valley EMS Agency Program Policy Paramedic Training Program Approval/Requirements Effective: 04/01/2013 Next Review: As Needed 1005 Approval: Troy M. Falck, MD Medical Director Approval:

More information

Emergency Medical Technician (EMT) Renewal Options and Requirements for EMTs with Certification Expiring on March 31, 2017

Emergency Medical Technician (EMT) Renewal Options and Requirements for EMTs with Certification Expiring on March 31, 2017 Emergency Medical Technician (EMT) Renewal Options and Requirements for EMTs with Certification Expiring on March 31, 2017 There are four (4) renewal options for EMTs with certification expiring on March

More information

AMERICAN OSTEOPATHIC BOARD OF FAMILY PHYSICIANS (AOBFP) 330 E. Algonquin Rd., Suite 6 Arlington Heights, IL

AMERICAN OSTEOPATHIC BOARD OF FAMILY PHYSICIANS (AOBFP) 330 E. Algonquin Rd., Suite 6 Arlington Heights, IL AMERICAN OSTEOPATHIC BOARD OF FAMILY PHYSICIANS (AOBFP) 330 E. Algonquin Rd., Suite 6 Arlington Heights, IL 60005 847-640-8477 email aobfp@aobfp.org APPLICATION FOR MODULE COMPLETION OSTEOPATHIC CONTINUOUS

More information

FIRESCOPE EMS Specialist Group San Diego Meeting September 15-16, 2014

FIRESCOPE EMS Specialist Group San Diego Meeting September 15-16, 2014 FIRESCOPE EMS Specialist Group San Diego Meeting September 15-16, 2014 Attendance: Ed Gandara LAC Jim Marugg SMG Mike Giannini MRN Greg Reynar LFD Pete Roebuck - CHO Ron Vega - CNT Bill Garrison LAC Scott

More information

ALABAMA DEPARTMENT OF MENTAL HEALTH BEHAVIOR ANALYST LICENSING BOARD DIVISION OF DEVELOPMENTAL DISABILITIES ADMINISTRATIVE CODE

ALABAMA DEPARTMENT OF MENTAL HEALTH BEHAVIOR ANALYST LICENSING BOARD DIVISION OF DEVELOPMENTAL DISABILITIES ADMINISTRATIVE CODE ALABAMA DEPARTMENT OF MENTAL HEALTH BEHAVIOR ANALYST LICENSING BOARD DIVISION OF DEVELOPMENTAL DISABILITIES ADMINISTRATIVE CODE CHAPTER 580-5-30B BEHAVIOR ANALYST LICENSING TABLE OF CONTENTS 580-5-30B-.01

More information

CHAPTER 37 - BOARD OF NURSING HOME ADMINISTRATORS SUBCHAPTER 37B - DEPARTMENTAL RULES SECTION GENERAL PROVISIONS

CHAPTER 37 - BOARD OF NURSING HOME ADMINISTRATORS SUBCHAPTER 37B - DEPARTMENTAL RULES SECTION GENERAL PROVISIONS CHAPTER 37 - BOARD OF NURSING HOME ADMINISTRATORS SUBCHAPTER 37B - DEPARTMENTAL RULES SECTION.0100 - GENERAL PROVISIONS.0101 AUTHORITY: NAME & LOCATION OF BOARD The "North Carolina State Board of Examiners

More information

1.2 General Authority for the promulgation of these rules is set forth in C.R.S

1.2 General Authority for the promulgation of these rules is set forth in C.R.S Section 1 - Purpose and Authority for Establishing Rules 1.1 The purpose of these rules is to replace the existing rules pertaining to emergency medical services with rules that will more adequately address:

More information

SIERRA-SACRAMENTO VALLEY EMS AGENCY PROGRAM POLICY REFERENCE NO. 1001

SIERRA-SACRAMENTO VALLEY EMS AGENCY PROGRAM POLICY REFERENCE NO. 1001 SIERRA-SACRAMENTO VALLEY EMS AGENCY PROGRAM POLICY REFERENCE NO. 1001 REQUIREMENTS AND APPROVAL PROCESS PURPOSE: To establish continuing education standards and define the roles and responsibilities of

More information

Practitioners may be recredentialed at any time, but in no circumstance longer than a 36 month period.

Practitioners may be recredentialed at any time, but in no circumstance longer than a 36 month period. SUBJECT: PRIMARY CARE AND SPECIALTY PHYSICIAN RECREDENTIALING SECTION: CREDENTIALING POLICY NUMBER: CR-02 EFFECTIVE DATE: 1/01 Applies to all products administered by the Plan except when changed by contract

More information

Definitions. The following words and phrases shall have the following

Definitions. The following words and phrases shall have the following 109-1-1. Definitions. The following words and phrases shall have the following meanings as used in this agency s regulations. (a) Administrator means the executive director of the emergency medical services

More information

LIBERTY DENTAL PLAN. Dental Hygienist - Credentialing Application. City: State: DEGREE: City: State: DEGREE:

LIBERTY DENTAL PLAN. Dental Hygienist - Credentialing Application. City: State: DEGREE: City: State: DEGREE: *Required Fields LIBERTY DENTAL PLAN Dental Hygienist - Credentialing Application Please complete one application per Dental Hygienist Demographic Information: Male Female *HYGIENIST NAME: RDH Other *DATE

More information

OREGON PRACTITIONER CREDENTIALING APPLICATION (Not an Employment Application)

OREGON PRACTITIONER CREDENTIALING APPLICATION (Not an Employment Application) OREGON PRACTITIONER CREDENTIALING APPLICATION (Not an Employment Application) Prior to completing this credentialing application, please read and observe the following: Healthcare Organizations may contract

More information

This chapter shall be known and may be cited as the "Alabama Athletic Trainers Licensure Act."

This chapter shall be known and may be cited as the Alabama Athletic Trainers Licensure Act. AL AT Act 12/04 Section 34-40-1 Short title. This chapter shall be known and may be cited as the "Alabama Athletic Trainers Licensure Act." Section 34-40-2 Definitions. As used in this chapter, the following

More information

Credentialing Application for Hospitals and Facilities

Credentialing Application for Hospitals and Facilities Instructions Credentialing Application for Hospitals and Facilities 1. Please accurately and legibly complete all sections of this Credentialing Application, and mark non-applicable fields with N/A. If

More information

Paramedic Application. Our Mission. The Application Process

Paramedic Application. Our Mission. The Application Process Page 1 of 9 Paramedic Application Our Mission To EducateFacilitateMotivate and prepare our students to proudly serve the community and continuously uphold our "Commitment to Excellence" The Application

More information

Maryland Commercial Air Ambulance Services

Maryland Commercial Air Ambulance Services State of Maryland Maryland Institute for Emergency Medical Services Systems 653 West Pratt Street Baltimore, Maryland 21201-1536 Lawrence J. Hogan, Jr. Governor Donald L. DeVries, Jr., Esq. Chairman Emergency

More information

I. PERSONAL INFORMATION. Degree and/or Title SS# . Non-physician Practitioner (Please specify )

I. PERSONAL INFORMATION. Degree and/or Title SS#  . Non-physician Practitioner (Please specify ) Pennsylvania Standard Application This form should be typed or legibly printed in black or blue ink. Please answer all questions completely and fully. If more space is needed than provided on this application,

More information

Jurisprudence. Documentation must be kept for 5 years

Jurisprudence. Documentation must be kept for 5 years 1 2 3 4 5 6 7 8 Jurisprudence What is a Jurisprudence Exam? Purpose A jurisprudence exam determines the of the Health and Safety Code Chapter 773, DSHS rules, and other applicable laws affecting the activities

More information

Credentialing Application

Credentialing Application Credentialing Application 1. NAME Last First MI Degree Gender 2. BIRTH, SOCIAL SECURITY & E-MAIL ADDRESS Date of Birth Social Security # E-Mail Address 3. PRACTICE, OFFICE & SPECIALTY INFORMATION 3.1 Please

More information

CAPTAIN - TRAINING OFFICER I (Fire Rescue)

CAPTAIN - TRAINING OFFICER I (Fire Rescue) *** This position is covered by a collective bargaining agreement *** **This position may require a physical ability/agility test** *This is a transitional, career ladder position requiring additional

More information

NASI Per Diem Malpractice

NASI Per Diem Malpractice Dear Nurse Anesthetist, We appreciate your interest in NASI s Per Diem Malpractice Insurance. This service is for those providers who need a supplemental policy for working an assignment outside of their

More information

SC Uniform Managed Care Provider Credentialing Application

SC Uniform Managed Care Provider Credentialing Application SC Uniform Managed Care Provider Credentialing Application I. PERSONAL INFORMATION Solo Practice Group Practice Name: Last First M.I. Suffix Degree Maiden and/or other name List W-9 name if different Place

More information

PARAMEDIC. Paramedic Degree and Certificate

PARAMEDIC. Paramedic Degree and Certificate Area: Health & Education Dean: Dr. Steven Boyd Coordinator: Dr. Grant Goold Phone: (916) 484-8843 or (916) 484-8902 Counseling: (916) 484-8572 http://www.arc.losrios.edu/programs_of_study/ Health_and_Education/Paramedic.htm

More information

[ ] DEFINITIONS.

[ ] DEFINITIONS. 2.14 Sec. 2. [148.9982] REGISTRY. 2.15 Subdivision 1.Establishment. (a) By July 1, 2017, the commissioner of health 2.16 shall establish and maintain a registry for spoken language health care interpreters.

More information

Definitions. Each of the following terms, as used in the board s regulations, (a) AEMT means advanced emergency medical technician.

Definitions. Each of the following terms, as used in the board s regulations, (a) AEMT means advanced emergency medical technician. 109-1-1. Definitions. Each of the following terms, as used in the board s regulations, shall have the meanings meaning specified in this regulation.: (a) AEMT means advanced emergency medical technician.

More information

San Luis Obispo County Emergency Medical Services Agency

San Luis Obispo County Emergency Medical Services Agency Dear EMT Recertification Applicant: San Luis Obispo County Emergency Medical Services Agency 2180 Johnson Ave, 2 nd Floor, San Luis Obispo, CA 93401 Phone: 805.788.2511 Fax: 805.788.2517 www.sloesma.org

More information

MENTAL HEALTH MENTAL RETARDATION OF TARRANT COUNTY. Operating Procedure MC-033 Effective: January 1999 Managed Care Revised: April 2008 Page 1

MENTAL HEALTH MENTAL RETARDATION OF TARRANT COUNTY. Operating Procedure MC-033 Effective: January 1999 Managed Care Revised: April 2008 Page 1 MENTAL HEALTH MENTAL RETARDATION OF TARRANT COUNTY Operating Procedure MC-033 Effective: January 1999 Managed Care Revised: April 2008 Page 1 CREDENTIALING/RECREDENTIALING OF PROFESSIONALS I. PURPOSE:

More information

Sign and return included forms. (Authorization to Release Information Form, Background Check Form and Vehicle Use Agreement)

Sign and return included forms. (Authorization to Release Information Form, Background Check Form and Vehicle Use Agreement) To: Employees with Conditional Offers of Employment Re: Background Checks All offers of employment or participation in any activity involving minors in a University sponsored program with The University

More information

Legal Last Name First Middle Professional Title/Degree

Legal Last Name First Middle Professional Title/Degree IOWA STATEWIDE UNIVERSAL PRACTITIONER RECREDENTIALING APPLICATION Type or print responses in ink. A CV or See CV may not be use in lieu of completing any answers on this application. Review or complete

More information

YALE-NEW HAVEN HOSPITAL MEDICAL STAFF POLICY & PROCEDURE CONFLICT OF INTEREST

YALE-NEW HAVEN HOSPITAL MEDICAL STAFF POLICY & PROCEDURE CONFLICT OF INTEREST YALE-NEW HAVEN HOSPITAL MEDICAL STAFF POLICY & PROCEDURE CONFLICT OF INTEREST Definitions External financial interests can create conflicts when they provide an incentive to a Medical Staff member to affect

More information

BOARD of EXAMINERS for LONG TERM CARE ADMINISTRATORS (BELTCA) Margaret McConnell, RN, MA Chair, BELTCA

BOARD of EXAMINERS for LONG TERM CARE ADMINISTRATORS (BELTCA) Margaret McConnell, RN, MA Chair, BELTCA BOARD of EXAMINERS for LONG TERM CARE ADMINISTRATORS (BELTCA) Margaret McConnell, RN, MA Chair, BELTCA TODAYS TOPICS WHAT IS THE BUSINESS OF THE BOARD of EXAMINERS for LONG TERM CARE ADMINISTRATORS (BELTCA)

More information

CERTIFICATES OF FITNESS

CERTIFICATES OF FITNESS CERTIFICATES OF FITNESS Statutes and Regulations May 2018 Labor Standards and Safety Division Mechanical Inspection Jobs are Alaska s Future MECHANICAL INSPECTION CUSTOMER COUNTER LOCATIONS Main Office

More information

EMERGENCY MEDICAL SERVICES PROCEDURE MANUAL

EMERGENCY MEDICAL SERVICES PROCEDURE MANUAL EMERGENCY MEDICAL SERVICES PROCEDURE MANUAL December 1, 2017 (Replaces September 28, 20017 Version) SOUTHERN NEVADA HEALTH DISTRICT P.O. Box 3902, Las Vegas, NV 89127 THIS PAGE INTENTIONALLY BLANK 2 TERMS

More information

PROFESSIONAL CODE OF ETHICS FOR AHNCC CERTIFIED NURSES

PROFESSIONAL CODE OF ETHICS FOR AHNCC CERTIFIED NURSES PROFESSIONAL CODE OF ETHICS FOR AHNCC CERTIFIED NURSES The American Holistic Nurses Credentialing Corporation ("AHNCC") is a nonprofit organization that provides credentialing programs for nurses who practice

More information

CREDENTIALING APPLICATION Please complete all sections. Incomplete applications may delay the credentialing process.

CREDENTIALING APPLICATION Please complete all sections. Incomplete applications may delay the credentialing process. CREDENTIALING APPLICATION Please complete all sections. Incomplete applications may delay the credentialing process. PERSONAL IDENTIFICATION DATA Last Name: First: MI: Degree: Date of Birth: Social Security

More information

***CAPS will not begin processing your application until ALL of the above items (numbers 1-4) are returned***

***CAPS will not begin processing your application until ALL of the above items (numbers 1-4) are returned*** As a service to providers and the community, the Greater Louisville Medical Society (GLMS) offers a Centralized Application Processing Service (CAPS). The GLMS CAPS department verifies: education, training,

More information

Certified Registered Nurse Anesthetist (CRNA) Application. Full Name Nickname. Address. City State Zip County. Home Phone Cell Phone

Certified Registered Nurse Anesthetist (CRNA) Application. Full Name Nickname. Address. City State Zip County. Home Phone Cell Phone Certified Registered Nurse Anesthetist (CRNA) Application Date of Application: I. Personal Information: Full Name Nickname Address City State Zip County Home Phone Cell Phone Email Pager/Alt. Email Sex:

More information

**IMPORTANT ~ PLEASE READ**

**IMPORTANT ~ PLEASE READ** IMPORTANT ~ PLEASE READ EMT-I/85 2013 Dear EMS Professional: According to our records your National EMS Certification is due to expire on March 31, 2013. By offering a nationally uniform process for maintaining

More information

NCCP. National Continued Competency Program Overview

NCCP. National Continued Competency Program Overview NCCP National Continued Competency Program Overview State Recertification Model Use CA OR WA NV ID UT MT WY CO ND SD NE KS MN IA MO WI IL MI OH IN KY WV PA VA NY NH VT NJ DE MD ME RI CT MA AZ NM OK AR

More information

Massachusetts Integrated Application for Re-Credentialing/Re-Appointment

Massachusetts Integrated Application for Re-Credentialing/Re-Appointment Massachusetts Integrated Application for Re-Credentialing/Re-Appointment Name (Please type or print) Degrees MA License. Are you currently in the United States on a temporary visa? ** **Identify type of

More information

Instructions and Application for Speech Language Pathologist Method 3, Meet all requirements for certifications(s) but do not have certification

Instructions and Application for Speech Language Pathologist Method 3, Meet all requirements for certifications(s) but do not have certification HEALTH OCCUPATIONS PROGRAM Speech Language Pathology and Audiology P.O. Box 64882, St. Paul, Minnesota 55164-0882 Telephone: (651) 201-3726 Fax: (651) 201-3839 Email: health.slpa@state.mn.us Instructions

More information

First Aid/CPR Training Program Application Packet

First Aid/CPR Training Program Application Packet First Aid/CPR Training Program Application Packet Submit completed application and supporting documentation to: Contra Costa Emergency Medical Services Attn: First Aid/CPR Training Program Approval 1340

More information

DEPARTMENT OF REGULATORY AGENCIES. Office of Addiction Counselor Program

DEPARTMENT OF REGULATORY AGENCIES. Office of Addiction Counselor Program DEPARTMENT OF REGULATORY AGENCIES Office of Addiction Counselor Program 4 CCR 744-1 AUTHORITY The authority for the promulgation and adoption of these rules and regulations by the Director of the Division

More information

EMS Jurisprudence Course

EMS Jurisprudence Course EMS Jurisprudence Course The El Paso County Community College District does not discriminate on the basis of race, color, national origin, religion, gender, age, disability, veteran status, sexual orientation,

More information

Facility and Ancillary Credentialing Application INSTRUCTIONS

Facility and Ancillary Credentialing Application INSTRUCTIONS Facility and Ancillary Credentialing Application INSTRUCTIONS Please complete the application thoroughly in its entirety. The checklist below may not be exhaustive of all materials, but is provided as

More information

State Council Report May 9 th & 10 th, 2017

State Council Report May 9 th & 10 th, 2017 State Council Report May 9 th & 10 th, 2017 Staff Report As many of us know from our last meeting, Lee has been traveling across the state attending REMSCO meeting, she stated that many REMSCO s have a

More information

Risk Management in the ASC

Risk Management in the ASC 1 Risk Management in the ASC Sandra Jones CASC, LHRM, CHCQM, FHFMA sjones@aboutascs.com IMPROVING HEALTH CARE QUALITY THROUGH ACCREDITATION 2014 Accreditation Association for Conflict of Interest Disclosure

More information

Application for Agency License Renewal Bureau of EMS & Trauma

Application for Agency License Renewal Bureau of EMS & Trauma Application for Agency License Renewal Bureau of EMS & Trauma SECTION I SERVICE INFORMATION License No: Name of Service: Physical Address: City: County: State: Zip: Mailing Address: City: County: State:

More information

TN SKILLS MANUAL 1999 WHEN DO I RENEW???

TN SKILLS MANUAL 1999 WHEN DO I RENEW??? WHEN DO I RENEW??? The Tennessee Department of Health, Division of Emergency Medical Services renews EMT licenses on the EMT's birth month. The system was implemented to disseminate the mass number of

More information

Network Participant Credentialing Application

Network Participant Credentialing Application Please: Type or print legibly Complete all items. If an item does not apply, enter NA. Do not leave any items blank. Include the following with your application, if applicable: Copy of professional license(s)

More information

Notice of Rulemaking Hearing Tennessee Department of Health Division of Emergency Medical Services

Notice of Rulemaking Hearing Tennessee Department of Health Division of Emergency Medical Services Notice of Rulemaking Hearing Tennessee Department of Health Division of Emergency Medical Services There will be a hearing before the Division of Emergency Medical Services to consider the promulgation

More information

OHIO CHAPTER AMERICAN COLLEGE OF EMERGENCY PHYSICIANS POLICIES AND PROCEDURES INTERNATIONAL TRAUMA LIFE SUPPORT OHIO

OHIO CHAPTER AMERICAN COLLEGE OF EMERGENCY PHYSICIANS POLICIES AND PROCEDURES INTERNATIONAL TRAUMA LIFE SUPPORT OHIO OHIO CHAPTER AMERICAN COLLEGE OF EMERGENCY PHYSICIANS POLICIES AND PROCEDURES INTERNATIONAL TRAUMA LIFE SUPPORT OHIO February 1998 (revision) December 1999 (revision) June 2000 (revision) June 2002 (revision)

More information

247 CMR: BOARD OF REGISTRATION IN PHARMACY 247 CMR 21.00: REGISTRATION OF OUTSOURCING FACILITIES. Section

247 CMR: BOARD OF REGISTRATION IN PHARMACY 247 CMR 21.00: REGISTRATION OF OUTSOURCING FACILITIES. Section 247 CMR 21.00: REGISTRATION OF OUTSOURCING FACILITIES Section 21.01: Purpose 21.02: Outsourcing Facility Registration Requirements 21.03: Provisional Outsourcing Facility Registration Requirements 21.04:

More information

SILVER CROSS EMS SYSTEM SILVER CROSS HOSPITAL 1900 Silver Cross Blvd New Lenox IL, 60451

SILVER CROSS EMS SYSTEM SILVER CROSS HOSPITAL 1900 Silver Cross Blvd New Lenox IL, 60451 SILVER CROSS EMS SYSTEM SILVER CROSS HOSPITAL 1900 Silver Cross Blvd New Lenox IL, 60451 FALL 2018 EMT-BASIC EDUCATION PROGRAM APPLICATION AND REGISTRATION PROCESS Qualifications 18 years of age High school

More information

KENDALL FIRE DEPARTMENT AMBULANCE STANDARD OPERATING PROCEDURE. TITLE: EMT Duties, Requirements, and Lead EMT Clearance Procedure

KENDALL FIRE DEPARTMENT AMBULANCE STANDARD OPERATING PROCEDURE. TITLE: EMT Duties, Requirements, and Lead EMT Clearance Procedure KENDALL FIRE DEPARTMENT AMBULANCE STANDARD OPERATING PROCEDURE TITLE: EMT Duties, Requirements, and Lead EMT Clearance Procedure of Issue: 2/1/2013 Written by: S. Maslyn/KFD EMS Captain Purpose: The purpose

More information

COUNTY OF SACRAMENTO EMERGENCY MEDICAL SERVICES AGENCY. PROGRAM DOCUMENT: Initial Date: 12/06/95 Emergency Medical Technician Training Program

COUNTY OF SACRAMENTO EMERGENCY MEDICAL SERVICES AGENCY. PROGRAM DOCUMENT: Initial Date: 12/06/95 Emergency Medical Technician Training Program COUNTY OF SACRAMENTO EMERGENCY MEDICAL SERVICES AGENCY Document # 4510.13 PROGRAM DOCUMENT: Initial Date: 12/06/95 Emergency Medical Technician Training Program Last Approved Date: 07/01/17 Effective Date:

More information

Rutherford Co. Rescue

Rutherford Co. Rescue RCLAFA, INC. Rutherford Co. Rescue Application You are only allowed to check one that you are applying for: Reserve Status Specialty Rescue Team Part-Time Paid Employee This application must be completely

More information

APPLICATION FOR REAPPOINTMENT RESEARCH ASSOCIATE

APPLICATION FOR REAPPOINTMENT RESEARCH ASSOCIATE APPLICATION FOR REAPPOINTMENT RESEARCH ASSOCIATE Enclosed is an application for reappointment to the position of Research Associate. We ask that you review the shaded areas to assure that all current information

More information

PRACTICE INFORMATION AND LETTER AGREEMENT FORM. COMPLETE, SIGN AND RETURN TO: One Huntington Quadrangle Suite 1N09 Melville, NY 11747

PRACTICE INFORMATION AND LETTER AGREEMENT FORM. COMPLETE, SIGN AND RETURN TO: One Huntington Quadrangle Suite 1N09 Melville, NY 11747 PRACTICE INFORMATION AND LETTER AGREEMENT FORM COMPLETE, SIGN AND RETURN TO: One Huntington Quadrangle Suite 1N09 Melville, NY 11747 PERSONAL DATA Last Name First Name License Number Tax I.D. Number for

More information

KANSAS STATE BOARD OF NURSING Landon State Office Building 900 SW Jackson, Ste 1051 Topeka, KS (785)

KANSAS STATE BOARD OF NURSING Landon State Office Building 900 SW Jackson, Ste 1051 Topeka, KS (785) KANSAS STATE BOARD OF NURSING Landon State Office Building 900 SW Jackson, Ste 1051 Topeka, KS 66612-1230 (785) 296-4929 INSTRUCTIONS FOR COMPLETION OF RENEWAL APPLICATION Online Renewal is available!!!

More information

Guidelines for the SC Approved CONTINUING EDUCATION PROGRAM

Guidelines for the SC Approved CONTINUING EDUCATION PROGRAM Guidelines for the SC Approved CONTINUING EDUCATION PROGRAM Meets National Registry NCCP Recertification Requirements for EMT, AEMT, and Paramedic Published by South Carolina Department of Health and Environmental

More information

Statutes and Rules Updates Presented by: Kirk E. Masten, D.O. President, Medical Licensing Board of Indiana

Statutes and Rules Updates Presented by: Kirk E. Masten, D.O. President, Medical Licensing Board of Indiana Medical Licensing Board of Indiana Statutes and Rules Updates Presented by: Kirk E. Masten, D.O. President, Medical Licensing Board of Indiana Overview of existing regulations What changed? Overview of

More information

Parkview Hospital Medical Staff Bylaws Supplement Allied Health Practitioner Manual

Parkview Hospital Medical Staff Bylaws Supplement Allied Health Practitioner Manual Parkview Hospital Medical Staff Bylaws Supplement Allied Health Practitioner Manual PVH AHP Manual December 9, 2014 Table of Contents A. Comparison of Advanced and Dependent AHP 3 B. Authorizations of

More information

Joint Committee on Volunteer Permits EMERGENCY SERVICE VOLUNTEER WARNING LIGHT PERMIT APPLICATION PACKAGE

Joint Committee on Volunteer Permits EMERGENCY SERVICE VOLUNTEER WARNING LIGHT PERMIT APPLICATION PACKAGE Joint Committee on Volunteer Permits EMERGENCY SERVICE VOLUNTEER WARNING LIGHT PERMIT APPLICATION PACKAGE Rhode Island General Law 31-23- 11.1 requires that the use and installation of red and white flashing

More information

Attachment B ORDINANCE NO. 14-

Attachment B ORDINANCE NO. 14- ORDINANCE NO. 14- AN ORDINANCE OF THE COUNTY OF ORANGE, CALIFORNIA AMENDING SECTIONS 4-9-1 THROUGH 4-11-17 OF THE CODIFIED ORDINANCES OF THE COUNTY OF ORANGE REGARDING AMBULANCE SERVICE The Board of Supervisors

More information

ALABAMA BOARD OF EXAMINERS OF NURSING HOME ADMINISTRATORS ADMINISTRATIVE CODE CHAPTER 620-X-7 LICENSES TABLE OF CONTENTS

ALABAMA BOARD OF EXAMINERS OF NURSING HOME ADMINISTRATORS ADMINISTRATIVE CODE CHAPTER 620-X-7 LICENSES TABLE OF CONTENTS Nursing Home Administrators Chapter 620-X-7 ALABAMA BOARD OF EXAMINERS OF NURSING HOME ADMINISTRATORS ADMINISTRATIVE CODE CHAPTER 620-X-7 LICENSES TABLE OF CONTENTS 620-X-7-.01 620-X-7-.02 620-X-7-.03

More information

APPLICATION FOR PERMANENT LICENSURE IN SLP OR AUDIOLOGY REQUESTING RECIPROCITY WITH A CURRENT LICENSE IN ANOTHER STATE INSTRUCTIONS TO APPLICANTS

APPLICATION FOR PERMANENT LICENSURE IN SLP OR AUDIOLOGY REQUESTING RECIPROCITY WITH A CURRENT LICENSE IN ANOTHER STATE INSTRUCTIONS TO APPLICANTS STATE OF NORTH CAROLINA BOARD OF EXAMINERS FOR SPEECH AND LANGUAGE PATHOLOGISTS AND AUDIOLOGISTS POST OFFICE BOX 16885, GREENSBORO, NORTH CAROLINA 27416-0885 TELEPHONE 336-272-1828 Email: dsherwood@ncboeslpa.org

More information

TITLE 4. PROFESSIONS AND OCCUPATIONS CHAPTER 33. BOARD OF EXAMINERS FOR NURSING CARE INSTITUTION ADMINISTRATORS AND ASSISTED LIVING FACILITY MANAGERS

TITLE 4. PROFESSIONS AND OCCUPATIONS CHAPTER 33. BOARD OF EXAMINERS FOR NURSING CARE INSTITUTION ADMINISTRATORS AND ASSISTED LIVING FACILITY MANAGERS TITLE 4. PROFESSIONS AND OCCUPATIONS CHAPTER 33. BOARD OF EXAMINERS FOR NURSING CARE INSTITUTION ADMINISTRATORS AND ASSISTED LIVING FACILITY MANAGERS ARTICLE 1 GENERAL Section R4-33-101. Definitions R4-33-102.

More information

5. Name: Last First MI. Street Number and Name or P.O Box. City State ZIPCODE. City State ZIPCODE

5. Name: Last First MI. Street Number and Name or P.O Box. City State ZIPCODE. City State ZIPCODE 508 - ILLINOIS CERTIFIED DOMESTIC VIOLENCE PROFESSIONAL CERTIFICATION EXAMINATION APPLICATION PLEASE PRINT IN INK 1. Exam Date Applying For: 2. Exam Location 3. Fee: $175.00 February Chicago Area Certified

More information

To Apply for BlueCross BlueShield of South Carolina and BlueChoice HealthPlan

To Apply for BlueCross BlueShield of South Carolina and BlueChoice HealthPlan To Apply for BlueCross BlueShield of South Carolina and BlueChoice HealthPlan 1. Complete the SC Uniform Managed Care Provider Credentialing Application. 2. Enclose copies of the following items: A. State

More information

RULES AND REGULATIONS OF THE MAINE STATE BOARD OF NURSING CHAPTER 4

RULES AND REGULATIONS OF THE MAINE STATE BOARD OF NURSING CHAPTER 4 RULES AND REGULATIONS OF THE MAINE STATE BOARD OF NURSING CHAPTER 4 AS AMENDED 2015 The RULES AND REGULATIONS OF THE MAINE STATE BOARD OF NURSING are adopted and amended as authorized by Title 32, Maine

More information

PROCEDURE-STUDENT RECORDS

PROCEDURE-STUDENT RECORDS PROCEDURE-STUDENT RECORDS 3600P This procedure specifies the management of student records by the District. These procedures are aligned with the Family Educational Rights and Privacy Act (FERPA). Type

More information

Pennsylvania Certification by Reinstatement

Pennsylvania Certification by Reinstatement Pennsylvania Certification by Reinstatement Thank you for your interest in obtaining current registration of your Pennsylvania EMS Certification. This is the process whereby a person expired Pennsylvania

More information

Department of Defense INSTRUCTION

Department of Defense INSTRUCTION Department of Defense INSTRUCTION NUMBER 6495.03 September 10, 2015 Incorporating Change 1, April 7, 2017 USD(P&R) SUBJECT: Defense Sexual Assault Advocate Certification Program (D-SAACP) References: See

More information

BestCare Ambulance Services, Inc.

BestCare Ambulance Services, Inc. BestCare Ambulance Services, Inc. 35 Bedford Avenue Gilford, NH 03249-2204 603/527-9119 Transfers 603/527-3553 Business Quality Assurance Policy Plan and Procedure Effective Date: 12/1999 Reviewed: 3/2000

More information

Agency Guide for Recertification

Agency Guide for Recertification Agency Guide for Recertification Updated: October 2017 COPYRIGHT 2017 NATIONAL REGISTRY OF EMERGENCY MEDICAL TECHNICIANS, INC. 6610 Busch Boulevard P.O. Box 29233 Columbus, OH 43229-0233 (614) 888-4484

More information