EMS: Required State Forms
The forms listed on this page relate to Wisconsin EMS (Emergency Medical Services). Select a link to view, print, and use the file as needed. We regularly review and update the forms.
EMS forms and publications
Forms
- E-Licensing—Apply for a license online. All license applications now use one form in E-Licensing instead of each having their own form.
- Affidavit of No Social Security Number—EMS Professional License, F-00893 (Word)—Use this form if you don’t have a Social Security number but wish to apply for an EMS license or certificate. Either this form or a Social Security number is required to apply.
- Change of EMS Medical Director, F-47470—Complete this form if there’s a new EMS medical director.
- EMS Complaints and Investigation—Learn how to file a complaint against EMS.
- EMS E-Licensing Service Demographic Information, F-02570 (PDF)—Complete this form to make staff changes to an EMS service provider.
- EMS Patient Care Worksheet, F-47489 (PDF)—Use this form if you’re an ambulance service provider. It provides patient care information to the receiving facility.
- Request for Waiver of Administrative Rule for Licensure, F-00569 (Word)—Use this form to waive a license requirement that isn’t required by law.
- Feasibility documents