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This document is used for legal name changes or requests for duplicate wallet cards for Emergency Medical Services personnel. It requires submission of documentation as outlined in the checklist.
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How to fill out For Emergency Medical Services Personnel Certification Name Change or Duplicate Wallet Card
01
Obtain the 'For Emergency Medical Services Personnel Certification Name Change or Duplicate Wallet Card' form from the relevant authority's website or office.
02
Fill in your personal details including your current name, certification number, and any other required information.
03
Indicate the reason for the name change or the request for a duplicate card.
04
If applicable, provide legal documentation supporting the name change (e.g., marriage certificate, court order).
05
Review the form for accuracy and completeness.
06
Submit the completed form along with any supporting documents to the designated office either in person or via mail.
07
Pay any required fees related to the name change or duplicate card request.
08
Wait for confirmation of your application and the issuance of the new wallet card.
Who needs For Emergency Medical Services Personnel Certification Name Change or Duplicate Wallet Card?
01
Emergency medical services personnel who have legally changed their name and need the certification updated.
02
Individuals who have lost or damaged their current emergency medical services wallet card and require a duplicate.
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People Also Ask about
What is the EMS Act of 1972?
1972—Health Services and Mental Health Administration under the Dept of Health, Education, and Welfare becomes the lead agency for EMS, formalizing shift from primarily transportation service to emergency medical service. 1973—EMS Systems Act establishes 300 EMS systems throughout the country.
What is the Emergency Medical Care and Treatment Act?
EMTALA requires that anyone coming to an emergency department requesting evaluation or treatment of a medical condition, receives a medical screening examination. If they have an emergency medical condition, the hospital must provide stabilizing treatment, regardless of the patient's insurance status or ability to pay.
What is a medical wallet card?
A medical wallet reference card is used by health care providers in an emergency. If you are unconscious or unable to speak, the card's information helps them to give you the best care possible.
What regulates the standards for prehospital emergency care and the individuals who provide it directly?
The standards for prehospital emergency care and the people who provide it are governed by the laws in each state and are typically regulated by a state office of EMS.
What is the prehospital Emergency Medical Care Personnel Act?
Existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, governs local emergency medical services (EMS) systems, authorizes each county to develop an EMS program and designate a local EMS agency, and requires the Emergency Medical Services Authority to receive plans
What is the purpose of the emergency medical services EMS system?
Because EMS clinicians respond to all kinds of emergencies, hazards and natural and man-made disasters, they often work side-by-side with public safety colleagues in law enforcement and the fire service, with the primary mission of providing emergency medical care. EMS also plays a role in non-emergent medical care.
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What is For Emergency Medical Services Personnel Certification Name Change or Duplicate Wallet Card?
It is a form used by emergency medical services personnel to request a change of name on their certification or to obtain a duplicate wallet card if the original is lost or damaged.
Who is required to file For Emergency Medical Services Personnel Certification Name Change or Duplicate Wallet Card?
Any certified emergency medical services personnel whose name has changed or who has lost their certification wallet card is required to file this form.
How to fill out For Emergency Medical Services Personnel Certification Name Change or Duplicate Wallet Card?
To fill out the form, provide your current certification details, the reason for the name change or the request for a duplicate card, and any necessary identification and fees as specified by the issuing authority.
What is the purpose of For Emergency Medical Services Personnel Certification Name Change or Duplicate Wallet Card?
The purpose is to ensure that the emergency medical services personnel have accurate identification and certification details reflecting their current name or a replacement for their lost wallet card.
What information must be reported on For Emergency Medical Services Personnel Certification Name Change or Duplicate Wallet Card?
The information required includes the individual's full name, certification number, reason for name change or duplicate request, and any relevant identification documents.
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