• Ambulance Inspection Form
• Ambulance Service Inspection Manual

Annual Medical Director Forms

• Medical Direction Statement and Variance Renewal (license renewal)
• Annual Medical Director Skill Verification
• Sample Training Log - to be included with Annual Medical Director Skill Verification and Signed Rosters
• Medical Director Skill Assessment Verification-Designee
• ALS Medical Control Agreement

For use by ambulance services to provide information to the Office of EMS when a service director or medical direction change occurs.

Completed forms should be sent to the EMS Specialist assigned to your ambulance service.

• Medical Director Change Information Form
• Service Director Change Information Form

• BLS Medication Variance Application
• Initial Hardship Variance Application - To be completed by Advanced Life Support (ALS) or Basic Life Support (BLS) ambulance services applying for an Ambulance Staffing Hardship Variance in accordance with Minnesota Statutes, section 144E.101 for the first time.
• Renewal Hardship Variance Application - To be completed by ALS services who were previously approved for a staffing hardship variance or BLS services who were approved for a staffing hardship variance after July 1, 2024

Upon completion of the application, you will receive an email confirmation allowing the vehicle to be placed into service until the EMS Specialist can complete an inspection.