EMS Provider Application and Operational Plan
(Form DPH 7463)
An approved operational plan is the legal description under which an
EMS provider operates. EMT-Intermediate and EMT-Paramedic ambulance service providers have
long been required to develop and submit an operational plan for license
approval. Recent changes to Chapter HFS110 and 113 Wisconsin Administrative
Code mandate that all ambulance service and first responder providers in Wisconsin are required to develop and submit an operational
plan to the Department of Health Services (DHS). The
requirements for the operational plan can be found in Chapters HFS110,
111, 112
and 113
Wisconsin Administrative Code.
Before operating an EMS service, a county, city, town, village,
prospective or licensed EMS service provider, hospital or any combination
of these must first submit an operational plan for DHS review and
approval. The approval of this plan is a prerequisite to initiation
of EMS service in Wisconsin. Any changes to the plan must also be
submitted to the EMS Section and approved in writing and existing plans
must be reviewed at least once every two years.
To assist the ambulance providers in Wisconsin to meet the plan
requirements, an operational plan template has been developed. The
template includes all plan components required by administrative code. The
plan (effective 2/2006) consists of two parts. The first part, form
DPH 7463, is a multi-page document that provides a sort of inventory of
the ambulance service. The form includes instructions
for completion and submission to the Wisconsin EMS Section.
The second part is a listing of required plan components. While
some operational plan components are standard, some vary with the level of
service being provided. Specific operational plan components for
each level are listed as parts A, B, C, D and E of the application
form. Complete the operational plan form and continue with your plan
by identifying the level of care your service will offer and responding to
the plan components identified for that level. Both the form DPH
7463 and your responses to the operational plan component outline for your
level of service are required as part of the EMS Service Operational Plan.
Get the forms:
Contact
your appropriate program coordinator at the Bureau Communicable
Disease and Emergency Response for further information.
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Last Revised: July 31, 2009 |
