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The Designated NYS EMS Program Agency Serving Chemung,Schuyler & Steuben Counties
1058 West Church St. Elmira, NY 14905
Phone: 607-732-2354

Forms/Documents & Links for EMS Professionals

ALS Renewal Form

BLS Renewal packet

Aspirin Administration in-service        

Blood Glucometry Application includes:
Medical Director Verification

Blood Glucometry and Nebulized Albuterol policy

Notice of Intent to Possess and use Epinephrine Auto-Injector                                                  
Medical Director Verification doh-4362.pdf
EPI Collaborative agreement.pdf                                                                                                                 
EPI Pen Skill Verification.pdf

Helicopter Utilization form

Hospital diversion report form.pdf

Narcan Administration Program

Notice of Intent to Provide Albuterol (application)

Medical Director Verification

Online Medical Control Report

Photo ID Request

Pad Quality Assurance Report - Post-Use Of An Automated External Defibrillator

Public Access Defibrilation