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NEW YORK STATE DEPARTMENT OF HEALTH Wadsworth Center Blood Resources Program Empire State Plaza Albany, New York 12237For Office Use OnlyEmail: brp@health.ny.gov Web: www.wadsworth.org/regulatory/bloodprogramDate
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Obtain the ambulance service application form from the relevant agency or organization.
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Who needs ambulance service application to?

01
Individuals who require emergency medical transportation services.
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Patients who need to schedule non-emergency medical transportation.
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Ambulance service application is for individuals or organizations to request permission to operate an ambulance service.
Individuals or organizations looking to start or continue operating an ambulance service.
The application must be completed with all required information and submitted to the appropriate regulatory agency.
The purpose of ambulance service application is to ensure that all ambulance services meet the necessary standards and regulations for providing emergency medical care.
Information such as contact details, operating plan, equipment list, and staffing credentials must be reported on the application.
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