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STATE OF CALIFORNIA CIA 8016 (orig. 04/2001; rev. 01/2011) DEPARTMENT OF JUSTICE REQUEST FOR LIVE SCAN SERVICE Applicant Submission A0532 Emerge Med Tech LIC/Cert ORI (Code assigned by DOJ) Authorized
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How to fill out Sacramento County EMS Agency:

01
Obtain the necessary forms: Visit the Sacramento County EMS Agency website or their office to get the required forms. These forms will include information about the patient, medical history, and reason for seeking EMS services.
02
Complete patient information: Fill in the patient's personal details such as name, address, contact information, and date of birth. It is important to provide accurate and up-to-date information for proper record-keeping.
03
Provide medical history: Include any relevant medical history of the patient, such as pre-existing conditions, allergies, medications, and prior surgeries. This information helps the EMS agency understand the patient's health background and provide appropriate care during emergencies.
04
Specify the reason for seeking EMS services: Indicate the reason why the patient requires EMS services. This can range from medical emergencies like heart attack or stroke to non-emergency transportation, such as commuting for medical appointments.
05
Include insurance and payment details: If applicable, provide insurance information and payment preferences. This ensures that the patient's insurance coverage is billed correctly and that any outstanding payment is handled appropriately.

Who needs Sacramento County EMS Agency?

01
Residents of Sacramento County: The Sacramento County EMS Agency serves the residents within the county's boundaries. Anyone who resides in this region and requires emergency medical services or non-emergency medical transportation may need to utilize their services.
02
Visitors to Sacramento County: People visiting Sacramento County who encounter emergencies or need medical transportation may also rely on the Sacramento County EMS Agency. It is important for visitors to know that this agency is available to assist them in times of need.
03
Medical facilities and healthcare professionals: The Sacramento County EMS Agency works closely with medical facilities and healthcare professionals within the county. These entities may need to interact with the agency to coordinate patient transfers, request emergency medical assistance, or seek guidance on specific cases.
04
First responders and emergency personnel: First responders, including firefighters, paramedics, and emergency medical technicians, collaborate with the Sacramento County EMS Agency to provide efficient emergency care and transport. They depend on the agency's protocols, guidelines, and resources to effectively handle medical emergencies.
Overall, anyone in Sacramento County who requires emergency medical services, non-emergency medical transportation, or works in the field of emergency healthcare may benefit from or require the services provided by the Sacramento County EMS Agency.
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