Life Support Agency & Vehicle Licensure

The agency and vehicle licensing coordinator provides oversight of the licensing and inspection process for all life support agencies and life support vehicles. Responsibilities include:

  • Review and approval of all Life Support Agency and Life Support Vehicle Applications for licensure 
  • Review of all inspections required by the department for the agencies and vehicles 
  • Provide inspection follow-up for those agencies and/or vehicles deemed non-compliant

 

Derek Flory, BAS, EMT-P / IC

Life Support Agency and Vehicle Licensing Coordinator

Phone 517-335-8382 

Fax: 517-335-9434

Email: FloryD@michigan.gov

 

**Please note: The mailing address for the MDHHS-EMS Section has changed to P.O. Box 30437, Lansing, Michigan 48909.

Verify EMS Agency

 

Contact Information

 

Complete the appropriate Department forms and submit directly to:

MDHHS-EMS Section
Agency/Vehicle Licensing Application
P.O. Box 30437
Lansing, Michigan 48909
Phone: 517-335-8382
Fax: 517-335-9434

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Forms & Publications

All forms and publications are in PDF format unless otherwise noted.  To preview and download the PDF forms, you will need Adobe Acrobat Reader.  If you do not have this program, it can be downloaded from the Adobe website.

 

Medical Waste Registration Memo 8-7-19

 

Ambulance Operation Licensing

Life Support Agency Licensure and Inspection Manual V 1.3

 

PDF Version 1.3 (8/19)

 

Application to Operate Basic, Limited, & Advanced Services 

BHS/EMS-352 (Revision: 2016) 

Part 1: Life Support Agency License Application

BHS/EMS-180 (Revision: 02/27/18)

Part 2: Life Support Vehicle Application

BHS/EMS-181 (Revision: 02/27/18)

Vehicle Verification for Life Support Agency Renewal PDF (7/16/2019)

Certificate of Insurance for Life Support Agencies

BHS/EMS-0092 (Revision: 2016) 

Emergency Medical Services Personnel List

BHS/EMS-327 (Revision: 2017) 

Ambulance Safety Inspection (Transport ONLY)

BHS/EMS-316 (Revision: 2016) 

Ambulance Safety Inspection - Notarized Statement (Transport ONLY)

BHS/EMS-318 (Revision: 2016) 

Vehicle Operation Course Criteria

BHS/EMS-2007 

Manufacturers Certificate of Compliance (Transport ONLY)

BHS/EMS-314 (Revision: 2016) 

Data Collection Requirements 

 

MI-EMSIS / Data Page

 

Loaner Vehicle Application (New or Extended Loan)

Data Collection Requirement - MI-EMSIS

MI-EMSIS / Data Page

 

BHS/EMS-182 (Revision: 4-30-17)

Medical Waste Information (EGLE, Formerly the DEQ)) Website
   
Michigan Occupational Safety & Health Administration (MIOSHA) Website

CLIA Information

Instructions for obtaining CLIA Waiver     PDF
Michigan Department of Licensing and Regulatory Affairs CLIA  Website

Updated Equipment and Agency Requirements

Effective 7-1-19

Items listed under MCA Approved Equipment is only required if included in MCA protocols.

Equipment Changes Memo 4-18-19

Equipment Clarifications Memo 5-2-19

Equipment Changes Spreadsheet 5-1-19

MFR Vehicle Minimum Equipmenmt Requirements    (Updated 8-7-19)

BLS Transport Minimum Equipment Requirements     (Updated 8-7-19)

BLS Non-Transport Minimum Equipment Requirements   (Updated 8-7-19)

LALS Transport Minimum Equipment Requirements    (Updated 8-7-19)

LALS Non-Transport Minimum Equipment Requirements    (Updated 8-7-19)

ALS Transport Minimum Equipment Requirements    (Updated 8-7-19)

ALS Non-Transport Minimum Equipment Requirements    (Updated 8-21-19)

Required Life Support Agency Criteria (Updated 9-4-19)

 

 

 

Miscellaneous Publications

MEDCOM Requirements

MEDCOM (Revision 5/20/19)

Certificate Of Need (CON) Review Standards For Air Ambulance Services

CON Review Standards

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Frequently Asked Questions (FAQs)

How do I become licensed? 
What are the fees? 
What do I need to do to add or remove a vehicle from the Agency license? 
Does my agency have to be available to provide services at all times? 
How often do I have to renew my license? 

How do I become licensed? 

The appropriate forms need to be completed by the agency seeking licensure and submitted to the department.  These forms can be found on our website or you can contact our office at (517) 241-3026 to have them mailed to you.  

Form

Required by Agency

MFR

BLS

LALS

ALS

Part 1: Life Support Agency License Application (BHS/EMS 180)

Part 2 Life Support Vehicle License Application (BHS/EMS 181) 

X

Certificate of Insurance for Life Support Agencies (BHS/EMS 0092) 

Manufacturers Certificate of Compliance (Transport ONLY) (BHS/EMS 314 

 

X

X

X

Ambulance Safety Inspection (Transport ONLY) (BHS/EMS 316)

 

X

X

X

Ambulance Safety Inspection - Notarized Statement (Transport ONLY) (BHS/EMS 318)

 

Emergency Medical Services Personnel List (BHS/EMS 327)

X

Application to Operate (BHS/EMS 352)

 

Data Collection Requirements - MI-EMSIS 

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What are the fees? 

Licensing Fee's for Basic Life Support, Limited Advanced Life Support, and Advanced Life Support Agencies: 

Initial and renewal fee: $100.00 for the Agency License and a $25.00 fee per vehicle 

Late fees are enforced if license is not renewed by the expiration renewal date: $300 for the Agency License and a $100.00 fee per vehicle 

Licensing Fee's for a Medical First Responder Agency: 

No Initial or renewal fees apply. 

Late fees are enforced if license is not renewed by the expiration renewal date: $300 for the Agency and $100.00 fee per vehicle 

Remove or Downgrade a vehicle: 

No fee.

Add, Upgrade, or Replace a vehicle:

$25.00 fee per vehicle 

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What do I need to do to add or remove a vehicle from the Agency license? 

You need to complete form # BHS/EMS-181, Life Support Vehicle Application and submit it to the department.  If the vehicles are for transporting patients, you will also need to complete form # BHS/EMS-314.  If the transporting vehicle is two years from the date of manufacture, then you will also need to complete form # BHS/EMS-316 and BHS/EMS-318. 

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Does my agency have to be available to provide services at all times? 

Yes, all levels of licensed life support agencies need to be available to respond to pre-hospital emergencies 24/7. 

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How often do I have to renew my license? 

Life support agencies renew annually.  A renewal packet is mailed to your agency 90 days prior to the license expiration date. 

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