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MA DPH/OEMS 200-59 2023-2025 free printable template

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DPH/OEMs 20059 CONED ROSTER 01/2016Program Information: (This roster is for use with training programs that have DPH/OEMs continuing education numbers) PROGRAM TITLE (Print):PROGRAM SPONSOR (Print):PROGRAM
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How to fill out MA DPH/OEMS 200-59

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Obtain a copy of the MA DPH/OEMS 200-59 form from the official website or contact your local DPH office.
02
Read the instructions carefully to understand the required fields.
03
Fill out the 'Applicant Information' section with the necessary personal and contact details.
04
Complete any sections related to the organization, indicating the name, address, and type of organization as needed.
05
Provide details about the specific services you will offer, including any relevant certifications or licenses.
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Include any required documentation or additional information as specified in the instructions.
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Review the completed form for accuracy and completeness.
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Sign and date the form before submission.

Who needs MA DPH/OEMS 200-59?

01
Healthcare providers who are seeking to operate within the Massachusetts Department of Public Health's emergency medical services framework.
02
Organizations or individuals looking to provide medical services that require compliance with state regulations.
03
Medics and ambulance services applying for licensure or renewal to ensure compliance with local laws.
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MA DPH/OEMS 200-59 is a form used by the Massachusetts Department of Public Health's Office of Emergency Medical Services to collect information regarding emergency medical services responses and patient care.
Emergency medical service providers and agencies in Massachusetts that respond to calls for assistance are required to file the MA DPH/OEMS 200-59 form.
To fill out MA DPH/OEMS 200-59, you need to provide details such as patient demographics, nature of the emergency call, treatment provided, and transport information. Follow the instructions provided on the form carefully.
The purpose of MA DPH/OEMS 200-59 is to ensure proper data collection for tracking emergency medical services activities, improving response times, evaluating care quality, and guiding policy decisions related to EMS services.
Information that must be reported on the MA DPH/OEMS 200-59 includes the patient's age, gender, nature of the incident, involved personnel, assessment findings, procedures performed, and transport details.
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