Rhode Island Department of Health Center for Emergency Medical Services
3 Capitol Hill , Room 105 Providence, RI 02908-5097
1. Requirements for EMS practitioner licensure are established by the Rules and Regulations 216-RICR-20-10.2 available through the Center for EMS website at http://www.health.ri.gov/licenses
2. EMT licensure can be denied pursuant to the provisions of the Rules and Regulations 216-RICR-20-10.2. State- ments or documents may be considered sufficient cause to deny or revoke a license as an EMS practitioner in Rhode Island and may result in additional penalties as determined by law. The Department may conduct random application audits, requiring the EMS practitioner applicant to file proof of completion of the above training require- ments for renewal.
3. Should you have any questions regarding the EMS practitioner license requirements or completion of the application form, contact (401) 222-2401.
4. Please allow 4-6 weeks for applications to be processed. You can visit our website at http://www.health.ri.gov and click on Verify a License in order to check on the status of your application.
1. Complete all application materials as instructed. Please answer all questions. Incomplete questions or incomplete applications will not be processed. Please mark “NA” on questions that are Not Applicable.
2. Do not detach any full pages from this booklet.
3. Please type this application using the filliable form online then print the completed application.
4. Sign the application and return it with the required fee(s).
5. Mail the completed application to: (Do Not Hand Deliver)
Rhode Island Department of Health
Division of Emergency Medical Services
Room 104, 3 Capitol Hill
Providence RI 02908-5097
6. Faxed applications WILL NOT be accepted.
7.Do not submit the application without all applicable ORDER) information, documentation and fee(s).
*PERSONAL CHECKS WILL NOT BE ACCEPTED. PAYMENT MUST BE A (CASHIER’S CHECK OR MONEY
1. ALL applicants at any level must submit an ORIGINAL Bureau of Criminal Identification (BCI) report supportedby fingerprints. You must apply to the Department of AttorneyGeneral’s Office. For information on this process please visit: http://www.riag.state.ri.us/homeboxes/BackgroundChecks.php. Out-of-state applicants should check with the Attorney General’s office from their state of residence.
2. Photostatic copy (front and back) of a current - signed Healthcare Provider level or equivalent cardiopulmonary
resuscitation (CPR) card eg. (American Heart Association Healthcare Provider, American Red Cross Professional Rescuer, American Safety and Health Institute CPRPRO, Medic First Aid BLSPRO, or National Safety Council Professional Rescuer CPR). This card must be signed.
3. For First-Time Applicants - photostatic copy of HighSchool Diploma or GED
4. Photostatic copy of diploma or certificate from the licensed EMS training provider verifying completion of the EMT training program
5. EMR, EMT, AEMT and Paramedic Applicants - photostaticcopy of current NREMT Registration
In Addition to 1-6 Out of State AEMT Applicants Must Also Complete 6-8
specific to the level of licensure application.
6. Photostatic copy of EMS Practitioner license from a state otherthan Rhode Island, if applicable.
7.Photostatic copy of current registration with the National Registry of Emergency Medical Technicians if applying for
EMR, EMT, AEMT or Paramedic.
8.Interstate Verification Form completed by each state (other than Rhode Island) in which the applicant has been