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License as an Emergency Medical Services ... - Rhode Island

Rhode Island Department of HealthCenter for Emergency Medical Services3 Capitol Hill , Room 105 Providence, RI 02908-5097 Phone: (401) 222-2401 Fax: (401) 222-3352 TTY/TDD: (800) 745-5555 Revised 12/16/2020 jcpSelect the level of EMS License you are applying for (check one):EMR EMT AEMT Advanced Paramedic EMT-Cardiac (AEMT-C) Application For License as an Emergency Medical Services PractitionerFOR DEPARTMENT OF HEALTH USE ONLYA pprovedDeniedDate_____ By_____ EMT#_____ Expiration Date:_____*Do Not Hand Deliver - Application Must Be Mailed*Applicant - Print Name LAST NAMEFIRST NAMEMII am the spouse of someone in active military duty or the spouse of a reservistI am a military veteran with honorable dischargeI

Rhode Island Department of Health. Center for Emergency Medical Services. 3 Capitol Hill , Room 105. Providence, RI 02908-5097. Phone: (401) 222-2401

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