The following forms can be printed and used as needed. These forms are reviewed and updated periodically. (Please note that the license application forms for EMT, AEMT, Intermediate, and Paramedic licensure and for Emergency Medical Responder Certification have been redesigned into one form.)
- Note: All individual license applications are now only accepted electronically by following the Wisconsin E-licensing link.
- A Social Security number is required to apply for an EMS license/certificate. If you do not have a Social Security number and wish to apply for an EMS license/certificate, please complete form Affidavit of No Social Security Number - EMS Professional License, F-00893 (Word) and submit it as directed on the form.
Service Credentialing Forms
- RN, PA and MD Equivalency Form, F-00614 (Word)
- EMS Training Center Training Permit Eligibility Certification for Electronic In-Class Training Permits, F-00646 (Word)
- Service Director License Proxy for Individuals, F-00114 (Word)
- Patient Side Training Report, F-00703 (PDF)
- Ambulance Run Report Form, F-47119 (PDF)
- Ambulance Report Skills / Extended Comments Form, F-47300 (PDF)
- EMS E-Licensing Service Demographic Information, F-02570 (PDF)
- Change of EMS Medical Director Form, F-47470 (PDF)
- EMS Complaints
- Form WKC 8165 Determination of Exposure to Blood/Body Fluids can be ordered from the Wisconsin Department of Administration (DOA) Document Sales website. Form WKC 8165 is sold in quantities of 25. On the DOA Document Sales website, search for SKU number SBD10781.
- EMS Patient Care Worksheet, F-47489 (PDF)
- EMS Provider Application and Operational Plan
- Waiver of Administrative Rule for Licensure, F-00569 (Word)