Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1027 - EMS AGENCIES › Subchapter A - GENERAL REQUIREMENTS › Section 1027.2 - License and registration applications

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
License application.
An
					 application for an EMS agency license shall be submitted on a form or through
					 an electronic process, as prescribed by the Department. The application must
					 contain the following information as well as additional information and
					 documents that may be solicited by the application form:
(1) The name and mailing address of the
					 applicant and a primary contact person and telephone number at which that
					 person can be reached.
(2) The name
					 under which the applicant will be holding itself out to the public in
					 conducting its EMS agency operations and the address of its primary location in
					 this Commonwealth out of which it will be conducting its EMS agency operations.
					 If the applicant seeks to conduct EMS agency operations out of more than one
					 location, the address of its primary operational headquarters and each other
					 location out of which it intends to operate. If the applicant will be holding
					 itself out to the public under different fictitious names for the EMS agency
					 operations it will conduct at different locations, the fictitious name under
					 which it intends to operate at each location.
(3) The manner in which the applicant is
					 organized-corporation, partnership, limited liability company, sole
					 proprietorship, and the like.
(4)
					 The tax status of the applicant-profit or nonprofit.
(5) The type of EMS service or services the
					 applicant intends to provide.
(6)
					 The geographic area for which the applicant intends to provide the service for
					 each type of service it intends to operate. If the service is a type of service
					 that is dispatched by a PSAP, the geographic area, if any, in which it plans to
					 routinely respond to emergency dispatches.
(7) A personnel roster and staffing plan or
					 personnel rosters and staffing plans, if applicable.
(8) The number and types of EMS vehicles to
					 be operated by the applicant and identifying information for each EMS
					 vehicle.
(9) The communication
					 access and capabilities of the applicant.
(10) A full description of the EMS agency
					 services that it intends to provide out of each location and how it intends to
					 respond to emergency calls if it will not conduct operations out of a fixed
					 location or locations.
(11) The
					 names, titles and summary of responsibilities of persons who will be staffing
					 the EMS agency as officers, directors or other EMS agency officials, and the
					 same information pertaining to them that an EMS provider is required to report
					 under §
												1023.21(b)(1) and
					 (2) (relating to general rights and
					 responsibilities).
(12) Information
					 concerning any arrangement in which it has entered to manage an EMS agency or
					 any contract with an entity for that entity to exercise operational or
					 managerial control over the EMS agency, or to conduct the day-to-day operations
					 of the EMS agency.
(13) A statement
					 attesting to the veracity of the application, which shall be signed by the
					 principal official of the applicant.