EMS Provider Licensing

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SURVEY REQUEST
In order to serve you better, DSHS would like you to complete a short online survey at: https://dshsrlu.questionpro.com/ The information you provide will assist DSHS in its efforts to continually improve and become more responsive to the needs of its customers. Thank you in advance for your cooperation.


FIRST RESPONDER ORGANIZATIONS

For information and forms visit the First Responder Registration information page. 

If you need additional help or have questions about EMS First Responder forms or processing contact Daniel Williams at 512/834-6700 – Extension 2329

 


RULES

Texas Administrative Code 157.11, Requirements for an EMS Provider License
Texas Administrative Code 157.3, Processing EMS Provider Licenses and Applications     
Texas Administrative Code 157.12, Rotor-wing Air Ambulance Operations
Texas Administrative Code 157.13, Fixed-wing Air Ambulance Operations


FORMS AND DOCUMENTS

Notices
Update to Medicaid Surety Bonds for Ambulance Providers
Applications
Provider Licensing Application
Online Licensing (Renewal Only)
Checklists
Use the following checklist as a guide regarding required documentation and elaboration of each provider licensing requirement.  
Initial License
Renewal License
Site-Survey Checklist
Licensing forms

Administrator of Record

EMS Provider Declaration Form
EMS Personnel Form
EMS Station Location List
EMS Vehicle Form
Medical Director Form
Notifications / Changes Form
Replacement License / Authorization Form
Fees
Please note that money mail is to be submitted to a different address than submittals without payment.

Mailed Fee Payments

Use/Submit the below linked cover sheet and address for mailed fee payments:
Cover Sheet - Mailed Documents Containing Fee Payments

Overnight Delivery, Etc. with Fee Payments

Use/Submit the below linked cover sheet and address for overnight delivery(or parcels or express) with fee payments:
Cover Sheet - Overnighted Documents Containing Fee Payments

Any Submission with No Fee

Use one of the links below for the appropriate cover sheet and address for any submission with no fee payment:
Cover Sheet - General mail with no fee payments
Cover Sheet - Overnighted mail with no fee payments

 


 

CONTACT

For help or questions about EMS Provider forms or processing contact EMS Compliance Staff at 512/834-6700:
Christopher Meyer – Extension 2317
Denny Martin - Extension 2373
Victoria Myles - Extension 6725
Christina Coleman - Extension 2410

For technical assistance contact your local field office you can find a list of offices at: Regional Office Contact Information

 

 

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Last updated December 17, 2014