Lawriter - OAC - 4766-3-18 Incorporated by reference.

4766-3-18 Incorporated by reference.

(A) "Ambulette Inspection" form or form "EMS 4019" (February, 2017) can be accessed at the division's website athttp://www.ems.ohio.gov/medical-transportation-forms.aspx.

(B) "Application for Ambulette License" form or form "EMS 4002" (July, 2013) can be accessed at the division's website athttp://www.ems.ohio.gov/medical-transportation-forms.aspx.

(C) "Deletion of Vehicle" form or form "EMS 4012" (April, 2016) can be accessed at the division's website at http://www.ems.ohio.gov/medical-transportation-forms.aspx.

(D) "Headquarters Change of Address" form or form "EMS 4004" (April, 2016) can be accessed via the division's website athttp://www.ems.ohio.gov/medical-transportation-forms.aspx.

(E) "Periodic Mechanical Safety Report" form or form "EMS 4039" (May, 2016) can be accessed via the division's website athttp://www.ems.ohio.gov/medical-transportation-forms.aspx.

(F) "Renewal Application for Ambulette License" form or form "EMS 4041" (May, 2016) can be viewed at the division's website at http://www.ems.ohio.gov/medical-transportation-forms.aspx.

(G) "Temporary Ambulette Application" form or form "EMS 4010" (July, 2013) can be accessed via the division's website athttp://www.ems.ohio.gov/medical-transportation-forms.aspx.

(H) "Violation Notification" form or form "EMS 4029" (April, 2015), is issued by the board to an ambulette service/non-emergency medical services organization that is in violation of Chapter 4766. of the Revised Code and agency 4766 of the Administrative Code and can be viewed athttp://www.ems.ohio.gov/medical-transportation-forms.aspx.

Effective: 8/1/2017
Five Year Review (FYR) Dates: 03/15/2022
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.03