Rule 4765-1-03 | Incorporated by reference.
(A) "Advanced Emergency Medical Technician Refresher Training Program" or "Advanced Emergency Medical Technician Refresher Training Program Ohio Approved Curriculum" (May 2012) is a continuing education program established by the board. This document is available at the Ohio approved curricula website at https://ems.ohio.gov/programs- services/program-directors/approved-ems-ce-program/ohio-approved-curricula/ohio- approved-curricula.
(B) "Application for Certificate of Approval" or "Initial Application for Certificate of Approval" or form "EMS 1650" (April 2015) is made available to applicants who want to operate EMS continuing education training programs pursuant to section 4765.17 of the Revised Code and Chapter 4765-7 of the Administrative Code. This document is available at the division's forms and applications website at http://www.ems.ohio.gov/forms.aspx at the approved EMS CE program tab.
(C) "Assistant EMS Instructor Renewal Application" or form "EMS 1655" (August 2015) is made available to the holder of a certificate to teach as an assistant EMS instructor who wishes to renew the certificate. Access to this renewal application is available at the division's renewal website at https://services.dps.ohio.gov/EMSProviders.
(D) "Certificate of Accreditation Application" or "Initial Certificate of Accreditation Application" or form "EMS 1652" (September 2022) is made available to applicants who want to operate one or more EMS training programs pursuant to section 4765.17 of the Revised Code and Chapter 4765-7 of the Administrative Code. This document is available at the division's forms and applications website at https://ems.ohio.gov/forms-and-applications.
(E) "Certificate of Accreditation Renewal Application" or form "EMS 1659" (October 2022) is made available to applicants who want to renew an existing certificate to operate one or more EMS training programs pursuant to section 4765.17 of the Revised Code and Chapter 4765-7 of the Administrative Code. This document is available at the division's forms and applications website at https://ems.ohio.gov/forms-and-applications.
(F) "Certificate of Approval - Renewal Application" or form "EMS 1651" (April 2015) is made available to applicants who want to renew an existing certificate to operate an EMS continuing education training program pursuant to section 4765.17 of the Revised Code and Chapter 4765-7 of the Administrative Code. This document is available at the division's forms and applications website at http://www.ems.ohio.gov/forms.aspx.
(G) "Emergency Medical Responder Refresher Training Program" or "Emergency Medical Responder Refresher Training Program Ohio Approved Curriculum" (May 2012) is a continuing education program established by the board. This document is available at the division's Ohio approved curricula website at https://ems.ohio.gov/programs- services/program-directors/approved-ems-ce-program/ohio-approved-curricula/ohio- approved-curricula.
(H) "Emergency Medical Technician Refresher Training Program" or "Emergency Medical Technician Refresher Training Program Ohio Approved Curriculum" (May 2012) is a continuing education program established by the board. This document is available at the division's forms and applications website at http://www.ems.ohio.gov/forms.aspx at the EMS training program curriculum and education standards tab.
(I) "EMS Application - Initial" or form "EMS 0010" (February 2018) is the application for an emergency medical responder, emergency medical technician, advanced emergency medical technician, or paramedic certification issued by the board. The application is made available to eligible applicants through an online portal.
(J) "EMS Continuing Education Instructor Initial Application" or "Continuing Education Instructor Initial Application" or form "EMS 0089" (August 2015) is the application for a certificate to teach as an EMS continuing education instructor issued by the board. This document is available at the division's forms and applications website at http://www.ems.ohio.gov/forms.aspx.
(K) "EMS Continuing Education Instructor Reinstatement Application" or "Continuing Education Instructor Reinstatement Application" or form "EMS 5924" (August 2015) is made available to the holder of an expired, revoked, or voluntarily surrendered certificate to teach as an EMS continuing education instructor who wishes to reinstate the certificate. This document is available at the division's forms and applications website at http://www.ems.ohio.gov/forms.aspx.
(L) "EMS Continuing Education Instructor Renewal Application" or "Continuing Education Instructor Renewal Application" or form "EMS 1514" (August 2015) is made available to the holder of a certificate to teach as an EMS continuing education instructor who wishes to renew the certificate. Access to this renewal application is available at the division's renewal website at https://services.dps.ohio.gov/EMSProviders.
(M) "EMS Reciprocity Application" or form "EMS 5911" (April 2024) is made available to a potential applicant for an EMS provider certificate issued by the board, to provide documentation of training received from another state or a branch of the United States military. This packet can be accessed at the division's forms and applications website at https://ems.ohio.gov/forms-and-applications.
(N) "EMS Renewal Application" or "EMS Application-Renewal" or form "EMS 0043" (August 2016) is made available to applicants who want to renew the certificate to practice. Access to this renewal application is available at the division's renewal website at https://services.dps.ohio.gov/EMSProviders.
(O) "Exemption Request for Continuing Education for EMS Certificates" or form "EMS 5933" (April 2021) is made available for certificate holders who wish to request that the board waive part of or all of the continuing education or instructional requirements needed to renew. This document is available at the division's forms and applications website at http://www.ems.ohio.gov/forms.aspx.
(P) "Fire and Emergency Services Instructor I & II Course Packet" or form "EMS 0112" (July 2024) includes the fire and emergency services instructor course overview, course admission requirements, qualifications for certification, course objectives, and recommended hours guide. The packet is made available to students, instructors, and program directors and can be accessed at the division's fire charter and EMS course materials website at https://ems.ohio.gov/forms-and-applications.
(Q) "Fire and Emergency Services Instructor Initial Application" or form "EMS 0086" (August 2024) is the application for a fire and emergency services instructor I, or a fire and emergency services instructor II, certificate to teach issued by the board. The application is made available to eligible applicants through an online portal.
(R) "Fire and Emergency Services Instructor Renewal Application" or form "EMS 1102" (August 2024) is made available to a holder of a certificate to teach who wishes to renew the certificate to teach. The application is made available to eligible applicants through an online portal.
(S) "Fire and Emergency Services Instructor Reinstatement Application" or form "EMS 0109" (August 2024) is made available to individuals wanting to regain a fire and emergency services instructor certificate that has expired, been voluntarily surrendered, or been revoked and can be accessed at the division's forms and applications website at https://ems.ohio.gov/forms-and-applications.
(T) "Fire and Emergency Services Instructor Reciprocity Application" or form "EMS 0098" (August 2024) is made available to an applicant who wishes to be issued a fire and emergency services instructor certificate to teach by the board, based on training received from another state or a branch of the United States military. Division staff mail form "EMS 0098" to a potential applicant following that person's completion and the division's review of the "Fire and Emergency Services Instructor Reciprocity Packet" or form EMS 5918, which can be can be accessed at the division's forms and applications website at https://ems.ohio.gov/forms-and-applications.
(U) "Fire and Emergency Services Instructor Reciprocity Packet" or form "EMS 5918" (August 2024) is made available to a potential applicant for a fire and emergency services instructor certificate to teach issued by the board, to provide documentation of training received from another state or a branch of the United States military. This packet can be accessed at the division's forms and applications website at https://ems.ohio.gov/forms-and-applications.
(V) "National EMS Education Standards" (December 2021) is approved by the NHTSA and establishes the minimum performance standards, or professional competency required for service as an emergency medical responder, emergency medical technician, advanced emergency medical technician, or paramedic. This document is used for classes that began on or after September 1, 2012 and is available at the division's forms and applications website at https://www.ems.gov/resources/search/?category=education&sort=date.
(W) "Ohio Approved EMS Curriculum Standards" or "Ohio Approved EMS Curriculum Standards EMS Instructor Guidance" (February 2012) establishes the scope and sequence of an emergency medical responder, emergency medical technician, advanced emergency medical technician, or paramedic training program. This document is used for classes that began on or after September 1, 2012 and is available at the division's forms and applications website at https://ems.ohio.gov/forms-and-applications.
(X) "Paramedic Refresher Training Program" or "Paramedic Refresher Training Program Ohio Approved Curriculum" (May 2012) is a continuing education program established by the board. This document is available at the division's approved EMS CE program - Ohio approved curricula website at https://ems.ohio.gov/programs-services/program-directors/approved-ems-ce-program/ohio-approved-curricula.
(Y) "Physician EMS Instructor or Physician Continuing Education Instructor Initial Application" or form "EMS 0052" (August 2015) is the application for a certificate to teach as a physician EMS instructor issued by the board. This document is available at the division's forms and applications website at http://www.ems.ohio.gov/forms.aspx.
(Z) "Physician EMS Instructor or Physician Continuing Education Instructor Renewal Application" or form "EMS 1648" (August 2015) is made available to the holder of a certificate to teach as an EMS instructor who wishes to renew the certificate. Access to this renewal application is available at the division's renewal website at https://services.dps.ohio.gov/EMSProviders.
(AA) "Regional Physicians Advisory Board Membership Application" or form "EMS 0096" (February 2022) is made available to a physician who wishes to be appointed by the board pursuant to section 4765.05 of the Revised Code to oversee the delivery of prehospital EMS in a region of the state. This document is available at the division's forms and applications website at http://www.ems.ohio.gov/forms.aspx.
(BB) "Request for Extension of EMS Certificates" or form "EMS 0084" (August 2017) is made available for certificate holders who wish to request an extension of time to complete the continuing education and/or instructional requirements needed to renew an EMS certificate. This document is available at the division's forms and applications website at https://ems.ohio.gov/forms-and-applications.
(CC) "Rescue Task Force Awareness Training" or
(1) "Course ID WBT906" or "Rescue Task Force Awareness Training" (January 1, 2021) is the board approved, one-credit hour, web-based, narrated online module available at the Ohio department of public safety training campus at https://learning.dps.ohio.gov/PSTC; or
(2) "Rescue Task Force Awareness Module - Active Shooter" or "Rescue Task Force Response to Active Shooter Incidents" powerpoint presentation (September 2019) is the board approved, one-credit hour module available at the division's additional resources website at https://ems.ohio.gov/programs-services/program-directors/accredited-ems-program/resources/rescue-task-force-awareness-module-active-shooter.
(DD) "Roberts Rules of Order Newly Revised, (12th edition)," is a manual of parliamentary procedure used to conduct meetings of the board, its committees, ad hoc committees, and subcommittees. It is generally available at public libraries. Additional information may be accessed at http://www.robertsrules.com/.
(EE) "Title 45 of the Code of Federal Regulations (C.F.R.) subtitle A, section 160.103 (January 25, 2013) of the health insurance portability and accountability act (HIPAA) of 1996" includes the definition for "individually identifiable health information." The C.F.R can be accessed via the "Electronic Code of Federal Regulations" website at https://www.ecfr.gov/.
Last updated September 2, 2025 at 7:52 AM
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