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Initial EMS Certification Application Packet
EMS Provider certification based on a current EMS provider certification from another state or with the National Registry of Emergency Medical Technicians. F Proof of valid EMS certification from another state or national certifying agency approved by the department. Send the attached EMS Verification Form to all states you have or
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Home Care Aide Certification Application Packet
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www.doh.wa.govemployment verification form from the employer they worked for between January 1, 2011 and January 6, 2012. F Out-of-State Credential Verification Form: If you worked as a healthcare provider in another state or jurisdiction, submit a copy of the verification form to each state you hold or have held a healthcare license,
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www.sheridanmedgroup.comprivacy, a form for release of medical information must be completed prior to receipt of these materials. All patients can request a copy of their medical records one time, free of charge. Additional copies may be requested at a cost of $0.75 per page. The law allows Medical Offices 30 days to complete requests for records.