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Sample Authorization to Practice Forms Posted to CSEMS Website – Now including Formulary items

SAMPLE Provider Clearance/Authorization to Practice Forms

At the request of agencies in the region, we have provided SAMPLE Authorization to Practice forms to assist in meeting the new “Red Dot” documentation requirements for scope of practice. These forms have been reviewed by the OEMS Division of Regulation and Compliance as meeting the standard, and address the EMT1/EMT2 items in CSEMS local protocols. Forms include some skills that are not in regional protocols, because we have agencies that have implemented agency supplements. The forms are fillable with drop-down menus for provider level (EMT) and whether you use Regional, Agency, or Regional with agency supplemental protocols. The forms are in “protected” mode, but are not password protected. Agencies may adapt the form to meet local needs, and add your agency letterhead (see regulations on page 2 of the form for requirements). Please submit a helpdesk ticket if you need any assistance. Remember this is an AGENCY-SPECIFIC requirement, and cannot be met by a regional document. Each provider must have specific authorization to practice by the agency’s medical director, and the record of training must be in each employee’s file.

Post expires at 4:52pm on Friday July 22nd, 2022