Form preview

Get the free Notice of Proposed Revocation: EMT-Basic Certification # 549622 - nj

Get Form
This document communicates the New Jersey Department of Health and Senior Services' intent to revoke the EMT-Basic certification of Charles Coleman due to failure to comply with an investigation regarding
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign notice of proposed revocation

Edit
Edit your notice of proposed revocation form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your notice of proposed revocation form via URL. You can also download, print, or export forms to your preferred cloud storage service.

Editing notice of proposed revocation online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
To use our professional PDF editor, follow these steps:
1
Register the account. Begin by clicking Start Free Trial and create a profile if you are a new user.
2
Upload a file. Select Add New on your Dashboard and upload a file from your device or import it from the cloud, online, or internal mail. Then click Edit.
3
Edit notice of proposed revocation. Replace text, adding objects, rearranging pages, and more. Then select the Documents tab to combine, divide, lock or unlock the file.
4
Get your file. Select the name of your file in the docs list and choose your preferred exporting method. You can download it as a PDF, save it in another format, send it by email, or transfer it to the cloud.
With pdfFiller, it's always easy to work with documents. Try it!

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out notice of proposed revocation

Illustration

How to fill out Notice of Proposed Revocation: EMT-Basic Certification # 549622

01
Obtain the Notice of Proposed Revocation form from the appropriate regulatory agency or their website.
02
Fill in your personal information, including full name, address, and contact details.
03
Provide your EMT-Basic Certification number (#549622) in the designated section.
04
Include the date of the notice and any reference or case number if applicable.
05
Clearly state the reasons for the proposed revocation as outlined by the agency.
06
If applicable, attach supporting documents or evidence that address the issues leading to the proposed revocation.
07
Review the form for accuracy and completeness before submitting.
08
Sign and date the form to confirm your acknowledgment of the notice.
09
Submit the completed form to the appropriate regulatory body by their specified method (mail, email, online submission).
10
Keep a copy of the submitted notice for your records.

Who needs Notice of Proposed Revocation: EMT-Basic Certification # 549622?

01
Individuals who hold an EMT-Basic Certification (#549622) and have received a notice regarding the potential revocation of their certification.
02
EMT professionals who are seeking to understand the implications or process related to their certification status.
03
Any parties involved in the investigation or review of the EMT's professional conduct or compliance with certification standards.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.0
Satisfied
45 Votes

People Also Ask about

Therefore, it is important to manually recertify your Virginia certification after 2 years, in order to keep the CE report reflective of what is needed for NREMT. NCCR (Cat 1) – Only 5 General Areas: Airway, Cardiovascular, Trauma, Medical and Operations.
Florida EMT Recertification The EMT National Continued Competency Program (NCCP) requires a total of 40 hours of continuing education to recertify. The model requires continuing education in three components: (1) a national component, (2) a local/state component, and (3) an individual component.
Inactive status is designated for Nationally Certified EMS clinicians who are not actively working or volunteering in EMS, or do not have an agency affiliation or Training Officer/Medical Director verification of skills and education.
You have two options to renew it: complete 40 hours of CE (there are lots of paid and free online courses out there) or pass the NREMT written exam again. You must complete this and submit your recert application by the expiration date or your NREMT will be lapsed.
A lapsed NREMT certification means that your certification has expired. This typically happens if you fail to renew it before your expiration date or decide not to renew your National certification. When your certification lapses, the NREMT no longer recognizes you as a certified EMT or paramedic.
Lapsed certificate means the status of a certificate of an individual who did not meet all of the requirements of certificate renewal and has not requested prior to the renewal deadline that the board place the certificate on inactive status.
Nationally Registered EMTs (NREMT) are required to renew their certification every two years. NREMTs can recertify by either taking the cognitive examination or by completing continuing education.

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

The Notice of Proposed Revocation: EMT-Basic Certification # 549622 is a formal notification issued by the relevant regulatory body indicating that there is a proposal to revoke an individual's EMT-Basic certification due to certain violations, misconduct, or failure to meet required standards.
The regulatory body or agency responsible for overseeing EMT-Basic certifications is required to file the Notice of Proposed Revocation if it determines that there are grounds for revocation based on specific criteria.
To fill out the Notice of Proposed Revocation, the filing entity must provide specific information including the certified individual's details, the reasons for revocation, supporting evidence, and any relevant administrative or procedural information as required by the regulatory guidelines.
The purpose of the Notice of Proposed Revocation is to formally inform the individual of the intent to revoke their certification, outline the reasons for this action, and provide the individual with an opportunity to respond or contest the proposed revocation.
The Notice of Proposed Revocation must report the individual's full name, certification number, the specific violations or issues that warrant revocation, any relevant dates, and information on how the individual can respond or appeal the proposed action.
Fill out your notice of proposed revocation online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.