PA DEPARTMENT OF HEALTH - EMS CLASS REGISTRATION FORM

I certify that the equipment as listed in the Accreditation Standards and/or curricula will be available to the instructors and students for demonstration and practice. I further certify that the skills and knowledge objectives listed in the National Standard Curriculum, as adopted by the Department of Health, or curricula specified on this application will be presented.

For classes leading to certification/recognition by the PA DOH, I certify that the course will be conducted in accordance with the Prehospital Personnel Manual and will meet all the didactic and clinical objectives and hours required by the Department. For classes leading to the award of PA DOH continuing education credit, I certify that the course will be conducted in accordance with the Continuing Education Manual.