Form - FORMS (12VAC5-31)

Current through Register Vol.. 38, No. 17, April 11, 2022

EMT Clinical Training Summary Record, EMS.TR.05 (rev. 8/2012)

Training Program Complaint Form, EMS.TR.30 (rev. 1/2011)

Course Approval Request, EMS.TR.01 (rev. 6/2011)

CTS Payment Request Form, EMS.TR.CTS.001 (rev. 6/2012)

EMS Variance/Exemption Application for Providers, EMS 6036 (rev. 6/2011)

EMS Variance/Exemption Application for Agencies, EMS 6037 (rev. 6/2011)

Course Summary Form, EMS.TR.03 (rev. 6/2011)

EMS Certification Application, Form A (undated)

EMS Training Program Enrollment Form, Form E (undated)

EMS Continuing Education Registration Card (undated)

Application for EMS Agency License (rev. 8/2012)

Application for EMS Vehicle Permit and Instructions (rev. 8/2012)

Complaint Report Form (rev. 11/2010)

Operational Medical Director Agreement (rev. 8/2012)

ALS-Coordinator Application, EMS.TR.31 (rev. 11/2011)

Emergency Medical Services Medical Record (rev. 6/2010)

BLS Course Student Information Package, EMS.TR.09 (rev. 5/2012)

ALS Course Student Information Package, EMS.TR.10 (rev. 5/2012)

BLS Individual Age, Clinical and Skill Performance Verification, EMS.TR.33 (rev. 1/2011)

Student Permission Form For BLS Students Less Than 18 Years Old, EMS.TR.07 (rev. 7/2011)

Physician Assistant & Nurse Practitioner Paramedic Challenge Competency Summary, EMS.TR.37 (rev. 2/12)

Program Accreditation Application, Instructions and Self Study - Paramedic (rev, 7/2012)

Program Accreditation Application, Instructions and Self Study - Intermediate (rev. 7/2012)

Alternative Site Application for EMS Programs in Virginia (rev. 7/2012)

Rescue Squad Assistance Fund Grant Application, Office of Emergency Services (

EMS System Initiative Award Application, Office of Emergency Services (

OEMS Grant Program Memorandum of Agreement (rev. 1/2012)


Amended, Virginia Register Volume 32, Issue 06, eff. 1/4/2016.

Statutory Authority: ยงยง 32.1-12 and 32.1-111.3 of the Code of Virginia.

The following state regulations pages link to this page.

State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.