(B) "29 C.F.R.
1910.1030" (April 3, 2012) covers exposure
to blood or other potentially infectious materials.
(C) "45
C.F.R.
164.512" (January 6, 2016) specifies
what information can be shared under the HIPAA laws.
(D) "Application for Ambulance or
Mobile Intensive Care License" form or form "EMS 4001" (January, 2018) can be
accessed at the division's website at
http://www.ems.ohio.gov/medical-transportation-forms.aspx.
(E) "Change in Level of Service
Medical Transportation Organization" form or form "EMS 4011" (July, 2013) can
be accessed at the division's website at
http://www.ems.ohio.gov/medical-transportation-forms.aspx.
(F) "Deletion of Vehicle" form or
form "EMS 4012" (April, 2016) can be accessed at the division's website at
http://www.ems.ohio.gov/medical-transportation-forms.aspx.
(G) "Headquarters Change of Address"
form or form "EMS 4004" (April, 2016) can be accessed at the division's website
at http://www.ems.ohio.gov/medical-transportation-forms.aspx.
(F)
The MTLS online
system collects and manages information in categories including service
details; medical director; call volumes; communication equipment; service
areas; contact information; insurance details; vehicle liability; company
executives; satellite locations; vehicle information; and facility and vehicle
inspection information. MTOs register and create an account to access the MTLS
online system and use it to apply for, renew, and manage a medical
transportation license.
(J)(H)
"Periodic Mechanical Safety Report" form or form "EMS 4039" (
June, 2017
July 2021)
can be accessed at the
division's website at
http://www.ems.ohio.gov/medical-transportation-forms.aspx.
(K) "Renewal Application for
Ambulance or Mobile Intensive Care License" form or form "EMS 4040" (May, 2018)
can be viewed at the division's website at
http://www.ems.ohio.gov/medical-transportation-forms.aspx.
(L) "Temporary Ambulance / MOICU /
Non-transport Vehicle" form or form "EMS 4009" (April, 2016) can be accessed at
the division's website at
http://www.ems.ohio.gov/medical-transportation-forms.aspx.
(M)(I) "
Violation
Notification" form or form "EMS 4029" (
July,
2018
July 2021) is issued by the
board to
a
MTO that is in violation of Chapter 4766. of the Revised Code and agency 4766
of the Administrative Code and
a sample of the
form can be viewed at the
division's website at
http://www.ems.ohio.gov/medical-transportation-forms.aspx.
Notes
Ohio Admin. Code 4766-4-18
Effective:
6/15/2022
Five Year Review (FYR) Dates:
3/23/2022 and
03/01/2027
Promulgated
Under:
119.03
Statutory Authority:
4766.03
Rule Amplifies:
4766.03
Prior Effective Dates: 08/01/2017,
02/01/2020
