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Forms


Photo of the publication cover. EMS TSFA Trauma System Development Application FY22 EMS Committees - Form October 13, 2020

This document describes the required process for eligible trauma system development projects to receive funding. Funding will be issued through a separate agreement between each approved organization and the New Mexico Department of Health Memorandum of Agreement process.



Photo of the publication cover. JOE Instructor Coordinator Transfer Request EMS Committees - Form October 20, 2017

This is a document to be filled out when an Instructor Coordinator is changing his/her training institution affiliation or adding an affiliation with a training institution.



Photo of the publication cover. JOE Instructor Coordinator Re-Entry Application EMS Committees - Form July 14, 2017

This is the re-entry application for instructor/coordinators.



Photo of the publication cover. JOE Instructor Coordinator Renewal Application EMS Committees - Form July 14, 2017

This is the renewal application for existing instructor/coordinators.



Photo of the publication cover. JOE Instructor Coordinator Initial Application EMS Committees - Form July 14, 2017

This is the initial application for new instructor/coordinators.



Photo of the publication cover. JOE Education Designee Form EMS Committees - Form May 19, 2017

This form is applicable for the following entities to utilize: the director and medical director of the academy, and the director and medical director of each approved emergency medical services training program, the state emergency medical services medical director, and the bureau chief whose designee shall serve without vote.



Photo of the publication cover. JOE Proxy Form EMS Committees - Form May 19, 2017

This form is applicable for the following entities to utilize: Each emergency medical services regional office training coordinator and providers from the three highest levels of licensure, who are appointed by the secretary from a list proposed by the statewide EMS advisory committee.



Photo of the publication cover. EMS RETRACS TPIC Performance Improvement Reporting Form EMS Committees - Form November 27, 2013

This form should be used to report performance improvement issues.